12942 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRNTT NUMBER
CITY OF CUPERTINO 12942
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
10832 W. ESTATES DRIVE
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IF WORK
DwrvER ED FOLZ CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICALD `
ISSUANCE DATE
MECHANICAL nn BLDG. ELECT. I PLG. MECH.
El El/
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ,,` I% 1�L / BUILDING PERMIT
WOOD FLOOR UL INFORMATION
PLUMBING VALUATION
MECHANICAL Of �upef
ELECTRICAL - PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE •
HES IND CON PS 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST _ TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. Acc.DATE Acc.FIND.FRAMING SANINSULATION PLUMBING zoNlrvc ENG.S
GAS
MECHANICAL FIRE SPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.D.
LATH—EXTERIOR FI RE DEPT. Y❑ N❑ Y ❑ �N❑
SHEETROCK GRADE - - -
SHEAR INTERIOR FEE SUMMARY
BUILDING
SHEAR EXTERIOR - - TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCUUVANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED
BY BUILDING INSPECTOR.
I MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! ' coNsr.rax
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 LD1 NG PROJECT 1 DENTI FICATI ON PERMIT NUMBER .
BUILDING APPLICATION & PERMIT t
ADDRESS 12 9 4 2
'+ r BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OwrvER'a PLAN CHECK VALIDATION
NA QTY. ELECTRIC PERMIT FEE
PHOCOqTNN
N°M " ORS ..iJOUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.NO. ( `' LIGHTING FIXTURES 10.00/1.00
CONTRACTORS L PPLIANCES-RESIDENTIAL 4.00
E55
( PHONE PANELS 10.00 DATE OF APPLICATION
ORCHITE PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlv TEMP,METER OR POLE INS. 20.00
aFPucarvrs MOTORS SEE FEE SCH. /7 '
ADDRE PPLICA
SERVICE CHANGE 1 .r,j 20.00
0 0 Z.
LICENSED CON'T'RACTORS DECLARATION .N sp �Uv �//�/��
a w I hereby affirm that I am licensed under provisions of Chapter 9 ' ISSUANCE GATE
Nay (commencing with Section 7000)of Division 3 of the Business and V \u. BLDG. ELECT. PLG. I MECH.
H m z Professions Co and my license"in full for •and cff rot. r f1f C r ❑ ❑ ❑
o Z m W Liccnsc CI ss Lic.Num be a p
Date Contractor .
a x
2 .a BUILDING PERMIT
o: a OWNER-BUILDER DECLARATION
o w 0 INFORMATION
wg u y I hereby e[Dnn that I am exempt from the Contractor's License MISC.- REFER TO ORD
H u 0 v, Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requiresa permit to construct,alter,
ac R 3 improve,demolish,or repair any structure,prior to its issuance,also EL C, ONT LIC.NO ELEC. �y
0 LL re9uires the applicant for such permit to file a signed statement that �� I /.��j/ TOTAL yC/
e w m he is licensed pursuant to the provisions of the Contractor's License _ PERMIT TO
HiQLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe `&�7
4 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant lou civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
. property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
memsare net intended or offered for sale if,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that lie did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 REB IND CON PB Omer
❑ I,as owner of the properly,am exclusively contracting with - ❑ El El El Ellicensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLER$-1 INC 5 VB. 6.00 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 contractors)licensed pursuant to
the Contractor's License Law SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPE:NSA'HON DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of cu -e If set Ginsure.
or a certificate of Workers'Campers lion I is to a•`yr a certified ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab.C..
Policy No. Company -
O �❑,1 Certi fie opy is hereb'�(uro
Z 2 ttf Cetli d c y f QJ yvft1, 11, ity in ecfion division. FIRE SPRINK ENERGY T-24
FO App icant. t/Q{,/y�l wr - MISC.- REFER TO ORD. v❑ N❑ v ❑ N❑
CC T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
LU > COMPENSATION INSURANCII-y, PLG.CONTR. LIC.NO.•' PLG.
EL O (This section need not be completed if the permit is for one TOTALLE Y❑ N❑ Y❑ N❑
� 2 hundred dollars(SIBD)or less.)
U O I certify that in the performance of the work for which this per. CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I 'lull not employ any person in any manner so as to
O w become subje [��C^m^ � o'California,
D. Date Appl'eant w ALTER OR ADD TO MECH. BUILDING
} m NOTICE.TO APPLICANT: If,after making this Certificate of Ex- 5.00
Z emptlon,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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. MICROFILM
3097,Civ.CJ. �'- HEATING UNIT TO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that1 have r ac dthis:plication and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
We) to Save, indent y a cep harmless the City of MISC.- REFER TO ORD.
Cope o aga st liabilities,j d m its, c sts .,,it expenses which CONST.TAX
may i any ay accrue ga s id Cit in copse uenc of the PERMIT ISSUANCE 10.00
rami Oft permit, . MECH.CONT. LIC.NO. MECH.
a lowTOTAL TOTAL
igna or pplicunt/' t -tor [e
OFFICE COPY