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15269 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15269 INSPECTION DIVISION JOB INSPECTION RECORD - - PERMIT EXPIRATION JOB ADDRESS 10401 North Blaney 'UNir#' _'LOT# PERMIT EXPIRES IF WORK OWNER Michael- ,Herman CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ ANCE OR•,180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE'SHALL BE INSTALLED ' PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS- - r^^- -• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -2r r7� Kcicr jam- -'"^"' • UNDERGROUND /SLABat yo,j PLUMBING ELECTRICAL ' ISSUANCE LATE MECHANICAL BLDG. ELECT. PLG. MECH. 0 El DO NOT POUR FLOOR UNTIL FLOOR ILE HAS BEEN SIGNED C` CV{�MID BUIINFORMATION L OIRG PERMIT WOOPLUMBING VALUATION S/FT, - - MECHANICAL - - ELECTRICAL r PERMIT To FRAMING .. :..L" .. t•�E.-! INSULATION - - - SrORIES TYPE CONSTR. {OCC.GROUP RES UNITS. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED v ` ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SW FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION,TAX IS PAID Y ROOF SHEAtHINGHES UsbIND ILDCON usePB om,•, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PAR CEL NO ROUGH SAN,N PLUMBING ELECT.ENERGY ' TRACT NO PARCEL NO TUBS 6 SHOWER PAN - -- PLUMBING ENERGY ' MECHANICAL MECH,ENERGY ELECTRICALjet, wBUILDING ENERGY - ACC.DATE -ACC.FILE NO. FRAMING - - ELECT.FINAL TEST ^Z INSULATION . PLUMBING _ ZONING ENG SITE NO. GAS TEST. GAS _ - - MECHANICAL ,2 �� _ FIRESPRINK ENERGY T 20 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N[] F] "❑ EXTERIOR SHEAR - � ELECTRICAL RELEASE FLOODZONE A.L UC. „ H INTERIOR SHEAR - FIRE DEPT. - Y❑ -F-1 ❑ 'No EETROCK - GRADE FEE SUMMARY E: TERIOR LATH @UILDING aJ_ I TERIOR LATH TEMPORARY APPROVAL BUILDING SC ATCH COAT ELECTRIC PLAN CHECK G FEE AS NO CAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC PEE ' OCCU ANCY OF BUILDING IS NOT PER MITTED UNTIL BUILDING FINAL 19SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC p " ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z }PLEASE GIVE JOB ADDRESS WHEN PHONING. ~ • = SEE PERMIT FOR EXPIRATION DATE — MECHANICAL. SO � �i IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. l✓ �r OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY - = BUILDING PROJECT IDENTIFICATION PERMIT NUMBER aUILOING APPLICATION & PERMIT 15269 aVILOIN �GVO� N� N� y�e BUILDING —ELECTRICAL—PLUMBING—MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME ' /Ay1am� 4y q� QTY. ELECTRIC PERMIT FEE •'1ACTORS r �rr,iPHDNE 2-bs CONTRACTORS rvamE 44 OUTLETS-SWITCHES-RECEP 10.00/1.00 sOo Se/� LIC.NO. / LIGHTING FIXTURES 10.00/1.00 0" CONTRACTOR'S / PPLIANCES-RESIDENTIAL 4.00 ON ADDRESS _ PHONE PANELS 10.00 " DATE OF APPLICATION ogcHDEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No., ENGINEER LIC.No. ISIGNS TRANS. 3.00 _ ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 2qQq APPLICANT'S ADDRESS MOTORS SEE FEE S SERVICE CHANGE o 0 o LICENSED CONTRACTORS DECLARATION a v v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 10 ISSUANCE DATE y ¢y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H Z z Professions Code,and my license Is LI full force and effect. C 0 m License Class Lic.Number W Date Contractor uy Qy� a m w a OWNER-BUILDER DECLARATION BUILDING PERMIT MISC. REFER TO ORD INFORMATION E: ;LL N I hereby affirm that I am exempt from the Contmclor's License VALUATION $/FT. FLL04 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE _4640 dkv w j E Code:Any city or county which mquiresa permit to construct,alter, Se a ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. rc requires the applicant for such permit to file a signed statement that - TOTAL ��1 I 1L tom" he is licensed pursuant to the provisions of the Contractor's License � PERMIT TO FiQ' Law(Chapter 9(commencing with Section 7000)ofInvision3ofthe Business and Professions Code)or that he is exempt therefrom and r M=$ the basis for the alleged exemption.Any violation of Section 7031.5 DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. a by any applicant fora permit subjects the applicant Con civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).1: ' X 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their stale compensation,will do the work,and the Structure is not intended or offered formle,(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 does such work FIXTURES-PER TRAP & SO.FT.FLOOR AREA TOTALACREAGE . ' mem$are me[ ownnemred for Role. ed that however,the improve- GAS-EA.SYSTEM-1 6.00 mems are not ugh his or offered for sale.IL however,the building Or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE RES- IND CON PB Other prove or purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ ❑ L as owner of the property,am exclusively.contracting with licensed contractors to construct the project(Sec: 7044,Business LAWN SPRINKLERS-1 INC 5 V. 0 ASSESSORS PARCEL NO. and Professions Code:Tim Contractor's License Law does not apply to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5( .00 Contracts for such projects with a mnlractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA. 0 /I O. TRACT NO. PARCEL NO. ❑ 1 am axe yt-nn er Sec. ,BAP.C.for this reason,�3 WATER HEATER W/VENT 6.00 Owner v' r*,•_T— WATER SYSTEM ACC.DATE ACC.FILE NO. WORKERS'COMPENSA'VION DECLARATION WATER TREATING EQUIP. 6.00 I hereby affirm that I have a ceNificale of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Ccsdil,cdcopyisherebyfurnished. FIRE$PRINK ENERGY T-Z4 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ [:] ❑ (] APPIiCaOf V N V N y CFRTIFICAI'1:OP EXEMPTION FROM WORKERS' - . PERMIT ISSUANCE i&00 /a '— FLOOD ZONE A.L.0 c. LU > COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. W � Z( This Section need not be completed if the permit is for one TOTAL �_ V❑ N Y ❑ NE]N hundred dollars($100)or loo U O 1 certify that in the performance of the work for which this per- QTY MECHANICALD FEE FEE SUMMARY LL F mit is issued.I shall not employ any person in any manner so as to PERMIT !A,'� O become subject to the Workers'Compensation Laws of California. y Date ApplicantBUILDING >_ N NOTICE TO APPLICANT'. If,after making this Certificate of Ex. ALTER OR ADD TO MECH. 5, F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.0 PLAN CHECK provisions of the Labor Code, you must forthwith comply withFEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10 CF.M.) 4.00 CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 SEISMIC FEE 1 hereby affirm thin there is a construction lending agency 1'ur / EXHAUST HOOD(WITH DUCT) 5.00 6 IQ the performance of the work for which this permit is issued fSee. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.19.50 JG, Lender's Names ELECTRIC • 1 ceNil'y-lime I have feed Misapplication and state lhai the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000B.T.U.) 6.00 hereby authorize representativesofthis city m enter upon the BOILER-COMP 6,, 100,000B7ulSEEFEESCH. MECHANICAL Tl above-mentioned property for inspection purposes. /d' S Juper We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. tino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE -}�B(} CONST.TAX i aceru a at st said Cit in conse uence of thef Of0 s MECH.CONT. LIC.NO. MECH. TOTAL Ste' TOTAL mare of Ap . a t/ o tractor Date / �� ��✓ OFFICE COPY •.