13033 (2) I
POST THIS CARD,NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 13033
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 7965 FOLKSTONE DRIVE UNIT# LOT# PERMIT EXPIRES IF\ORK
QQQ"' OWNER HUBERT ROSS CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSP CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ �.I ANCE OR 180 DAYS FROM
7$' SV 1'J NvU LASTCALLED INSPECTION.
UFER
PREGUNITE - LA (" PERMIT VAUDATION
Ie4 Qj( . YOLK
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED sowit IN t ,�
UNDERGROUND /SLAB /
PLUMBING I/
2/0/
ELECTRICAL ISSUANCE DATE
❑
❑ ❑
MECHANICAL aLOG. ELECT. PLG. mecR.
❑.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT.
MECHANICAL
ELECTRICALxPETRMIT TO
FRAMING A-D//71-6 N
INSULATION STO s TYPE CONSTR.
5/Yy
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM D
BUILDING USE
E INU CON PB O�nrr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING - _ _
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL �
ACC.DATE ACC.FILE NO.
ELECTRICAL
-/ FINALS DATE INSP.
FRAMING 6 SAN a ZONING ENG,SITE NO.
INSULATION PLUMBING -} ,
GAS p
MECHANICAL _jy'. FO FIRE SPR INK ENERGY T.2.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE AT.UG.Y E] N� Y F] NE]
— �
LATH-INTERIOR ELECTRICAL - Y' rv� Yo NEI
FIRE-�- FIRE DEPT. �.y_y. {.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING}
.91
SHEAR EXTERIOR TEMPOR RY APPR VALS BUILDING -�
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDIN G FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
U.1 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
HONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 7
1 O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL ?
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL r
CALLING FOR FINAL INSPECTION.
OFFICE COPY
t
f0 FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
"a- BL. , ING PROJECT IDENTIFICATION PERMIT NUMBER
BOLDING ,/ APPLICATION & PERMIT
tAODREss� O/-HS'7biVc _Dda. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13033
OWNER'a It PLAN CHECK VALIDATION
NAME N� QTY ELECTRIC PERMIT FEEMW
CONTRACTORS Q OUTLETS-SWITCHES-
.AYE RECEP 10.00/1.00 '7(�. e�r"
I LIC.NO. LIGHTING FIXTURES 10.00/1.00;2-.J-
CONTRACTORS
yCONTRACTORS PPLIANCES-RES
ADDR Ess IDENTIAL 4.00
r� PHONE PANELS 10,00 DATE OF AP PLICATION
ARCHITECT
(<' PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE
e J' E.GINEER^' �' 0� IOYA
1 Aac Llc..o.e�2 7p Z SIGNS TRANS. 3.00
�I. ADDRESS coop SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
i,P EMP.METER OR POLE INS. 20.00 ,y
APPLICANTS MOTORS SEE FEE SCH. C//1_7.1/-"•''_`�)
ADDRESS
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
¢ u v I hereby affum that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w (commencing Willi Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
Fr" D i Professions Code.and my license is in full force and effect.
zo',2- License ClassLic.Number
Q r Date Contractor
a y s BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION INFORMATION
U
X ;A G I hereby affirm that I um exempt from the Contractor's License MISC.-
REFER TO ORD
u04 Law forthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
H Code:Any city orcounry which requires a permit t.construct,olleq
aa, < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEC.
- D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
K
$ he is licensed pursuant to the provisions of the Contractor's License ��
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /71 Ql\,l
- a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r O the basis for the alleged exempliva.Any violulion of Seclion 7031.5 STORIES TYPE CONSTR.
by my applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 � S'.Vz
of not moa than five hundred dollars(5500).):
❑ I,as owner of Ibe property,.r my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure Is not - OCQC.GROUP RES.UNITS
intended or offered for sok (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 5,00 �-� SO.ET.FLOOR AREA TOTAL ACREAGE
himself or through his own empluyc......sided that such improve- /
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 �- Q
or Irl P..vemenl is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING usE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
Prov forpurposeofsnle.). INDUSTRIAL WASTE INTER. 30.00
I,as owner of the property,am exclusively contracting with
I' cl contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License law don not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractorls)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00
the Contract.,',License L.W. TRACT NO. PARCEL NO.
❑ I am :c Ipt and r .B.&P.C.for t is WATER HEATER W/VENT 6.00
reason
owner Detc WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
1
V I s IiCLARATION WATER TREATING EQUIP. - 5.00
I ertby affirm that I%have a cNifi,ale of consem to self-insure. ZONING ENG.SITE N0.
ser a certificate of Workers'Compenmlion Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city impectum division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ IN
M y CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
L > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. Y N v N
d 0 (This section need not be completed if the permit is for one TOTAL L
Z hundred dollars IS 100)or less I
U O 1 certify that in the pt,rfommnce of the work for Which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Worken'Compensalion Laws of California.
0 a Dao ApPli vat ALTER OR ADD TO MECH. 5.00 BUILDING
rn NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z weplion,you should become subject to the Worken'Compensation APPLIANCE 5.00 PLAN CHECK
U
provisions of
the ILabor Code, you must forlhwitb'comply with FEE
u
permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .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,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 16
lender's Name HEATI NO UNIT(OVER 100,000 B,T.U.)9.50 ELECTRIC a��
Lender's Addrtss
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
`
information u correct. 1 agree to comply with all oily and county PLUMBING
ordimnees end slate laws .staling to building construction, and BOILER,COMP 13 H.P.or 100,000 B.T.U.1 6.00
hereby authorize representatives of this city es enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL p=
about-mentioned properly Porins of
purposes. sv
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses whichPERMIT ISSUANCE 10,00 P� CONST.TAX
may in any way accrue against said City in co mer, the /p
Q n ng (this r - �/ Pl MECH.CONT. LIQ NO. MOETAHL TOTAL 101�l�
Ignalure of Applicant/Co ///
OFFICE COPY