12633 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 12633
INSPECTION DIVISION
. JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 7794 Huntridge Lane UNIT# _LOT#
' PERMIT EXPIRES IF WORK
OWNER Robbins CONTRACTOR A & HHeating IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION. ,
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL '
ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH
E] ❑. ❑ ;P
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION S/FT.
MECHANICAL
ELECTRICAL PERMIT TO
I I
FRAMING i 1
INSULATION STORIES TYPE CONSTR.
OCC.GROUP .RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
^� ROOF $O.FT,FLOOR AREA TOTALACREAGE
DIAPHRAGM It
BUILDING USE
RES IND CON PB O'ne'
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 ACG FILE NO.
FRAMING SAN #
INSULATION PLUMBING ZONING ENO.SITE NO.
GAS
MECHANICAL PIKE sPRJINK _ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ v ❑ No
LATH—INTERIOR - ELECTRICAL FLOODZA.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y❑ Y ❑ N❑
SHEETROCK GRADE
FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H -F
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
BU LDI14G PROJECT I DENTI FICATI ON PERMIT NUMBER
Isul GING APPLICATION & PERMIT
ADDRESS
.-1-10%q
-1-'10% i1 -A
ne LAki E:7 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 6 3
OWNER'S � PLAN CHECK VALIDATION
1�X rvnMEQTV. ELECTRIC PERMIT FEE
' \ PHONCONT4q
NAAMERACTORs OUTLETS-SWITCHES-RECEP 10.00/1.00
�( + �1 Eq _a: sm '44V2 ILIGHTING FIXTURES 10.00/1.00
CONTRDDRESGTGRs
APPLIANCES-RESIDENTIAL 4.00
A
1 `(D 7-MZ77--b?-1907.9;2PANELS 10.06 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on IPANELS (OVER 200 AMP) 20.00
ENGINEER
ED.No. SIGNS TRANS. 3.00
ARCH.OR ENG. _ SPECIAL CIRCUIT 5.00 PE ATION
ADDRESSZIP EMP. METER OR POLE INS. 20.00 (�
AMOTORS SEE FEE SCH. APR
ADDRESS SO 19v�
ORE
SERVICE CHANGE 20.00 �r� .{'
o o LICENSED CONTRACTORS DECLARATION City Of. CUpQE q(�O
a v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
H Q il, 'ommencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH,
H L C Professions Code n license is in full fur t� ❑ ❑ ❑
oi m W License Clas LIC.Number
u, H Dale Contractor
< y 4
¢ ¢w a OWNER-BUILDER DECLARATION BUILDING PERMIT
o A u INFORMATION
E
g& H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
H LL o a Law for the fallowing reason.(Sec.7031.5,Businessond Professions PERMIT ISSUANCE
VALUATION
Code:Any city or county which requires a permit to construct,alter, 10.00
Ra <O improve,demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.N0. ELEC.
as XG ¢ requires the applicant for such permit to file a signed statement that TOTAL
w m u- he is licensed pursuant to the provisions of the Contractor's License. PERMIT TO
is Law(ChapWr 9(commencing with Section 7000)of Division 3 ofthe
x o Business and Professions Code)or that he is exempt therefrom and
m m the basis for the allege)exmnp[ion.Any violation of Section 7031.5 QTY. PLUMBING PERMIT FEE
STORIES TYPE CONSTR.
n by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.1 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.urvtTS
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,AR EA,CON D. 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 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
menus are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
Of improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Prove for purpose of vale.). INDUSTRIAL WASTE INTER. 30.00 S IND C❑ON 0 Other
O L as owner of the property,he exclusively,7G44,[Bu with
licensed contractors to construe 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 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 contractoos)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
Cl lam exempt under Sec.-.B,&I,,C.for this
anon WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consem to self-insure,
or a certificate of Workers'Conhpansatiou Insurance,or u cerlifed ZONING ENG.SITE NO.
0 pj($ 38 0,Lab.CJ xw
folic) 8�V_41 pa,y Je�uL4STfJ _FPLG.CONTR. LIC.
.
❑ Certilled copy hs hereby furnished �Nll N/
Z . Ce ti Fopy I��f� huh II � city inspection di sion. FIRESPRINK ENERGYT-24
H0 AlQrlicant_�k'Irfy_1JSCfSC-A REFER TO ORD. y N� Y ❑ N�
Cr H CERTIFICATE OF EXEMPTION 1*ROM WORKERS' E 10.00
FLOOD ZONE A.LU.C.
W COMPENSATION INSURANCE. No.d 0 (This section need not be completed if the permit i,s for oneTOTAL Y❑ N Y� Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- NICAL PERMIT FEE SUMMARY
LL U mit is issued, I shall not employ any person in any nIDnmer so as to FEE
become subject to the Workers'Compensation Laws of California.
n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ W NOTICE 1'0 APPLICANT: If,after making this Certificate of Ex-
FZ emption,you should become subject to the Workers'Conhpensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10Mr.F.M) 4.00 FEE
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that then is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit Is issued(Sec ee 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 Ibis application and state 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 m 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 love.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 said City in consequence of(he PERMIT ISSUANCE 10.00
", ga ing of this pormit/ g / MECH.CONT. LIC.NO. MECH.
ly\ c IKQy,PC4cv �[ �(p � M
TOTAL
1 ,�c� TOTAL
gnature of Applicant onlra Uate G7�1�N y
OFFICE COPY //