14487 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER ,
CITY OF' CUPERTINO 14487
INSPECTION'DIVISION
JOBINSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS: 21651 HERMOSA AVE UNIT# _LOTO '
PERMIT EXPIRES IF WORK
OWNER CRAIG^'CLARK CONTRACTOR SAME Is NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION _ - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF' Pimil VAIJDATION -
CUPERTINO STANDARDS. I�I•U
GARAGE SLABS D N
POUR NO CONCRETEABOVE HAS
BEEN SIGNED JAy/i' vigel
UNDERGROUND
PLUMBING Citpy Ywt/Vyuwfi
no
ELECTRICALS - - Issunmce DATE
MECHANICAL BLDG ELEc PLG. MECH.
❑ ❑ ❑ -i
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BLALDING PERMIT
WOOD FLOOR - - INFORMATION
PLUMBING VALUATION P s/FyT;.L
MECHANICAL
ELECTRICAL - , PERMn ro a
FRAMING - r,V 5 -• ,
I
INSULATIONN - -STORIES TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
Sf),FT FIOOH RHEA TOTAL ACREAGE )
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOFSHEATHING " HES IND CON PB Opns
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED_, FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH sAN.a ASSESSORSPARCEL NO..
• '
PLUMBING - ELECT.ENERGY '
TUBS&SHOWER PAN, - - PLUMBING ENERGY TRACT No. PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILENO
FRAMING ELECT.FINAL TEST
INSULATION •. PLUMBING - zoNiNc ENC.SITE No.
GAS TEST IGAS -
MECHANICAL FIRE SPRINK ENERGY i.74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING E] N ` ❑ ND
FLODD ZONE A,L U C
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v❑ N❑ Y ❑ N❑
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT JELECTRIC PLAN CHECK
. GAS :FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ' ELECTRIC u) ✓
. Z ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING: .
— SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
-IMPORTANT! corvsT.TAX.
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,
_
- ,BUILDING PROJECT IDENTIFICATION APPLICATION Sl PERMIT PERMITNUMBER
^ ewLutNc
AvonySa6 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL x 14487
OWNERLR SS PLAN CHECK VALIDATION
NA//Mxr))EE e -770-231 QTY. ELECTRIC PERMIT FEE
VV/R/C PHONE.
NAMERAcroRs UTLETS=SWITCHES-RECEP 10.00/1,00
,V„I
L's-3 LIGHTING FIXTURES 10.00/1.00
CONTRAC
ADDR ESS TORS /I •■� APPLIANCES-RESIDENTIAL 4.00
/ oz)/ 06 Yy ,9✓6PHONE -'1q6 PANELS. 10,00 DATE OF APPLICATION
ARCHITECTPLAN(OVER 200 AMP) 20.00 PLAN CHECK FEE 'P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS
ADDRESSMOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 4- - lipp
w,00 LICENSED CONTRACTORS DECLARATION dJAN
fZ W I hereby AIR, that I am licensed under provisions of Chapter 9 ISSUANCEqDATE
a a (commencing with Section 7000)of Division 3 of the Business and BLD MECH.
E. D= Professions Code,and my license is in full farce and effect
E] ❑o i W License Class Lic.Number
m H
Date Contractor
< m s
¢ a
OWNER-BUILDER DECLARATION BILDING PERMIT
a.o o INFORMATION
X ;LL N I hereby affirm that I bm exempt from the Contractor's License MISC.- REFER TO ORD
a.O a Law for the following reason.(Sec.7031.5.Business and Professions VALUATION $/FT,
- PERMIT ISSUANCE • . 10.00
Code:Any my or coo my which mqu tune permit to construct,alter,
Q Q impinve,demolish,or repair any structure,prior to Els issuance,also ELEC.CONTE. LIC.NO. ELEC.
i c¢ requires the applicant for such permit m life a signed statement that TOTAL PERMIT TO
F
m m he is licensed pursuant to the provisions of the Contractor's License
F Z ¢
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe -
E 4 D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
It F_$ lire basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
Ate _ by any applicant for a parmit subjects the applicant tau civil puralty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ 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 ' t
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-
ments are not intended or offered for sale,If,however,the building GAS-EA.SYSTEM-111NC.40UTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or un - . -
RES IND CON PB - Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with '❑ ❑ 0 ❑ 0
licensed 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 dues not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such pro)aots with a contractor(s)licensed pursuant to $EWER-SANITARY-STORM EA.200ft/10,00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Lute WATER SYSTEM 5.00
ACC.DATE- ACF FILE NO.
WORK ERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or u certificate of Workers'Connpensa0on Insurance,or a certified
copy thereof(Sec.3600,Lab.C.). ,
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGY T74
Z Z O Certified copy is filed with the city inspection division. - - ❑ '❑ ❑
F REFER TO ORD
O Applicant MISC.- . y N y N❑
W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
LU COMI'ENSA1MN INSURANCE. PLG.CONTE. LIC.NO, PLG.
1 Cl (This section need nut be completed if the permit is for one TOTAL Y[:] N Y N
0 Z hundred dollars IS 100)or less.)
(J O 1 certify that hi the performxn a of the work r which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1-. or is issued,I shall na em RIO ny non n ry ma cr so as to
U beton 1�.�pt he Workers' nm aY awls of alil'ornia.
Dy Date-ir E/Q AvNicarn 1 _ - ALTER OR ADD TO MECH. 5.00 BUILDING
} ra NOl'ICE TO APPLICANT: If u r making t is Certificate of 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
C„) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 6.00 SEISMIC FEE
I hereby affum that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) '5.00
the performance the work for which this per tis'sued(Sec. - MICROFILM
3097, .C.). �`'P t HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name'' �7 �Y HEATI NG UNIT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC CI�
I certify 11.1 I have read I15 appliUibm and slate that the above VENTILATION FAN (SINGLE) 4.00
• intormalion is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating 90 building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby.authorize representatives of this city to enter upon the BOILER-COMP low.700,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 . CONST.TAX -
May in anj way accrue aiffirst sed City in consequence of the
granting a Ihjspe it. MECH.CONT. LIC.NO. MECH. - -
p TOTAL TOTAL g�
Signature of pf nu ontraclor Date SIC)od
OFFICE COPY