13372 (2) POST THIS CARD NEAR FRONT OF BUILDING
• PERMIT NUMBER
CITY OF CUPERTINO 13372
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10578 EAST ESTATES' .UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER SHARON DAVIS CONTRACTOR WOODWRIGHT IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LAST CALLEDrINSPECTION.
' PREGUNITE
PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ?pND * _
PLUMBING
ELECTRICAL - (j r,�
1�tt_q q ISSUANCE DATE
MECHANICAL v 5 ELECT. PLG. MECH.
ct of C� e ❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT. '
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING ' \^
INSULATION STORIES TYPE CONSTR.
OCL GROUP RES.UNITS
_ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 1:1.
1:1 1:1-
❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING Vf
GAS TEST TRACT NO, PARCEL NO
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN # -
INSULATION PLUMBING ZONING ENG.SITE NO.
0
GAS
MECHANICAL FIRE SPRINK ENERGY T-IC
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT. �, Y❑ IN[:j Y ❑ N❑
SHEETROCK
SHEAR INTERIOR GRADE - _ -
FEE SUMMARY
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF 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.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
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
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
uILDING APPLICATION & PERMIT
ADDRESS
(ocy�O 11 �' �''" �cS (fie BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 13372
OWNER'S PLAN CHECK VALIDATION
.
NAME
([�,�� '�y� s�,r O� QTY. ELECTRIC PERMIT FEE
9jKbftQ `NAq'(S PHONE \'T1� J
CONTRACTORS UTLETS-SWITCHES
AME -RECEP 10.00/1.00
umuly-1 t� _
KI UC.NO. l� LIGHTING FIXTURES 10.00/1.00
fo NTRAGioR's PPLIANCES-RESIDENTIAL 4.00
ADDRESS �R
(OZ14S U PHONE ( l\ /C PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMPI 20.08 PLAN CHECK FEE P.C.NO.
OR , 1A
ENGINEER fes/
f uc.No. SIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zap EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH. s4 QALtrLLil`J
ADDRESS
SERVICE CHANGE 20.00 p L�
w O o LICENSED CONTRACTORS DECLARATION A /
a' /
a v w I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
H z (commencing with Section 7000)of Division 3 of the Business and
w a u ) BLOG.f ELECT. PLG. MECH,
0 N i License Professions Code d y license is in full for n effp`[Z fJ , s„� ❑ ❑ ❑
0 O m - License Class_ Con Number ` c�
Q � � D UaR� - Contractor
y E t
IQqC I UILDING PERMIT
¢ ¢ OWNER-BUILDER DECLARATION �I
K o >v - INFORMATION
tu ;LL y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
r L04 Law for the following reason.(Sec.7031.5,BusinessandProfessions PERMIT ISSUANCE - 1000 VALUATION $/RT.
H0 Code:Any City or county whichrequiresa permit to construct,alter,
¢ ¢ a O improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
wD ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT�;O
$m he is licensed pursuant to the provisions of the Contractor's License
mJ�\J`S_
H Z > Law(Chapter 9(Comencing with Section 7000)of Division 3 ofthe Le,�1L
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ =$ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant o a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as 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 ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 So.FT FLOOR AREA TOTALACHEAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered 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 ofsaleJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Omar
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,BusinessLAWN SPRINKLERS. 1 INC 5 V.B. 600 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
contracts for such projects with a contractions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ [am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent m set '"sure,
or a certificate Of Workers'Compensa ion Insurance,ora a tified ZONING ENG,SITE N0.
copy thercof(Sce.3800,Lab.C.).
Policy N Company
❑ Cer Ie is hereby furnished. FIRE SPRINK ENERGY TY4
z Z ❑ Cerli - _ filed 'th the 'ly specs' division.
PO Applicant MISC- REFER TO ORD. YE] N(] Y ❑ N[]
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE AT.u.C.
L COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y[3 N❑ Y ❑ N
::� Z hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL
LL F- mit is issued,I shall not employ any person in any manner so as to PERMIT FEE FEE SUMMARY
O w become subject to the Workers Compensation Laws of California.
y Date Applicant BUILDING ��99
} as NOTICE TO APPLICANT: If,after making this Certificate of I:.- ALTER OR ADD TO MECH. 5.00 �`t L_
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
U
provisions of the Labor Code, you must forthwith comply with FEE such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE J'b
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.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
• I certify that I have read this application and state that 0m above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city; county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city In enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(we) agree to save, indemnify and keep harmless the City Of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against City in to,
of the PERMIT ISSUANCE 10.00
gt of this permi MECH.CONT. LIC.NO. MECH.
C. 7- 22 TorAL TOTAL
0
Signature of Applicant Contractor Date -�
OFFICE COPY '