14354 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14354
INSPECTION DIVISION
JOB INSPECTION RECORD
`.•
JOB ADDRESS 21721 COLUMBUS AVE UNIT## _LOT# PERMIT EXPIRATION
" - - PERMIT EXPIRES IF WORK
OWNER FATTH WPT.TQM CONTRACTOR IS NOT STARTED •WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - - ANC. OR.180 DAYS FROM
NOTE: :LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF -PERMIT VALID LION
CUPERTINO STANDARDS. •c 7 c
GARAGE SLABS `� r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - •' ( . 4
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG. ELECT I PLO 1MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT,
MECHANICAL.
ELECTRICALr PERMIT TO
.I
FRAMING _ 'fes-�-,' " '>�"� J.
INSULATION STORIES TYPE ONSTR.
' l
., OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF ,NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5° FT FLOORAREA TorAL ACREAGE
DIAPHRAGM _ THE CONSTRUCTION TAX IS PAID
_ BUILDING USE
ROOF SHEATHING -RES IND CON PB _o",
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
ELECTRICAL ACC DATE ACC.FILE NO
BUILDING ENERGY
FRAMING ELECT.FINAL TEST -
INSULATION - PLUMBING zow NO ENG.SITE NO.
GAS TEST GAS
FIRE SPRINK ENERGY h20
- MECHANICAL v � N❑ v � N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE A.L.0 C.
INTERIOR SHEAR FIRE DEPT. YE]. N[ • Y ❑ NQ•
SHEETROCK _ GRADE FEE SUMMARY
• EXTERIOR LATH BUILDING
INTERIOR -LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING i'lo
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—,SEE PERMIT FOR EXPIRATION DATE — MECHANICAL.
IMPORTANT!
CONST rnx '
PLEASE-READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL'IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
RUIDING APPLICATION & PERMIT A
ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 4
7 r
354
OWNER'S - PLAN CHECK VALIDATION
. NAME - TV. ELECTRIC PERMIT - FEE
NAMERAcroEs UTLETS-SWITCHES-RECEP 10.00/1.00
- LIC.NO. LIGHTING FIXTURES 10.00/1.00
AEAcroE's
ADDRESS
PPLIANCES-RESIDENTIAL 4.00 '
'
PHONE PANELS 10,00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE +' P.C.NO.
OR
ENGINEER -
Lie.NO. SIGNS TRANS. 3.00
moo ESS erv¢ SPECIAL CIRCUIT 5.00 PERMIT VALID ION
Z11 TEMP.METER OR POLE INS. 20.00 �y
ADDRESS MOTORS SEE FEE SCH.
AOREss �F
SERVICE CHANGE 20.00
o a LICENS17D CONTRACTORS DECLARATION
u U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
v,rt w (commencing with Section 7000)of Division 3 of the Businessand BLDG. ELECT. PLG MECH.
F m i Professions Code,and my license is in full force and effect. ❑ ❑ ED
Z x o License Class Lie.Number
2 m H J Date Contractor
a Y BUILDING PERMIT
Ic m w a OWNER-BUILDER DECLARATION INFORMATION
Wo A U REFER TO ORD
F 1 hereby affirm that I am exempt from the Contractor's License MISC.-
�+ LL y VA WATION $/FT.
uD ¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - 10.00
fN Code:Any cityorcounty which requires a permit to construct,after,4 ELEC.CONTE. LIC.NO.
¢ ¢O improve,demolish,or repair any structure,prior 4r its issuance,also ELEC.
O M requires the applicant for such permit to file a signed statement that TOTAL ^ PERMIT TO
whe is licensed pursuant to the provisions of the Contractor's License
Fi> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
s C Business and Professions Code)or that he isexempt therefrom and DTV. PLUMBING PERMIT FEE
IF P-$ the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES
TYPE ONSTR.
ce ;_ by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
eject more than five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their 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'.The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SG.FT.FLOOR AREA TOTAL ACREAGE
•
himselforthroughintends ownemployees,for sale.
If,ed that however,
Such improv"- GAS-EA.SYSTEM-1 6.00 `
mems are not intended Sold or offered for sales If,however,the building
or improvement is sold burden
of pr year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove
will have the burden of proving that he did not build or im' RES IND CON PB Other
prove 1,aso nee of stheJ. INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
contractors construct (heproject La 7044,Business LAWN SPRINKLERS-1 INC5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to owner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts
acts for such projects with a contr who hactorls)IicenseQpursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200([/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a Certificate of Consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y❑ ry❑ y [3 N[]
CO Applicant
CC w> I Cf:RTII%CA'fli OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE _ 10.00 / FLOOD ZONE A.L.U.C.
LU _ COMPF-NSATIONINSURANCE PLG.CONTR. LIC.NO. PLG, ❑ ❑ ❑ ❑
CL O (This section peed not he completed if the permit is for one TOTAL Y N Y ry
Z hundred dollars IS 1001 or less.)
V O 1 certify that in the performance of'the work for which(his per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issssuuedd,,I shall not employ any person in any manner So as to
U ecol�e sc porkers'Cyelpequ ioWL ufC'
or y ate CTY[t4X A licam fx_j-/(f / ALTER OR ADD TO MECH. 5.00 BUILDING
} h OTI A LICAN'f: If,alter I lakIng this Certi mate of F ? 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
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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. HEATING UNIT(TO 100,000 B'.T.U.) 8.00 MICROFILM
3097,Cie C.).
Lender's Name HEATING UNIT(OV ER l 00,000B,T,U.)8.50 ELECTRIC
Lender's Address
I certify that I have read this application and state than the above VENTILATION FAN (SINGLE) 4.00
information is correct. I'agree to comply with all city and county PLUMBING Ca
ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.Or100,000B.T.U.I 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection pamCars.
(We) agree to save, indemnify and keep harmless the City of MISC. REFER TO ORD.
upertino against liabilities,judgments, Costs and expenses which CONST.TAX
ay in a way accrue 'gains said City in consequence of the PERMIT ISSUANCE 10.00
ran 'n his it. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL !,O
ignefum of Applicant 'Onfractor - Data �x+ e
OFFICE COPY