13654 (2) POST THIS CARD NEAR FRONT OF BUILDING
. . - PFRMIT NUMBER 1
CITY OF CUPERTINO 13654
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
22419 JANICE AVENUE
JOB ADDRESS _ UNIT# ;LOT#, PERMIT EXPIRES IF WORK
OWNER .T . I - CONTRACTOR ACE - IS NOT STARTED WITF N
INSPECTION DATE INSPECTOR INSPECTION RECORD `180DAYS OFPERMIT ISSU-.
I ANCE OR 180 DAYS FROM
'FOUNDATION LASTCALLED INSPECTION.."
UFER
PR EGUNITE
PERdM T VA4!(LIDATION
' . � - `- �1�- 'dA
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AD�
UNDERGROUND /SLAB tt F1 �
PLUMBING . ' :CRY of. Upedlnn _
ELECTRICAL ISSUANCE.DATE A
BLDG'_ ELECT. PLG. MEc
MECHANICAL
❑ � 11_ ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - ' VALUATION B/FT.
PLUMBING
MECHANICAL 1, PERMIT To
ELECTRICAL, - -
FRAMING � ,::• "I". `j'
- STORIES TYPE CONSTR.
INSULATION
f
_ OCC.
. GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF , - n , Sp,FT.-FLOOR AREA .TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
• : ;. - / RES' IND CON PO 00—
APPLY NO HOOFING UNTIL ABOVE HAS BEEN SIGNEDEl1:111
ROUGH ? ASSESSORS PARCEL NO,
PLUMBING
GAS TESTI _ _ - �• TRACT NOi PARCEL NO.
MECHANICAL " �•,
ELECTRICAL FINALS:; DATE INSP. AOC.DATE Acc.FILE No.
FRAMING SAN 0 '
ZONING ENG.SITE NO.
INSULATION - I PLUMBING -
.. GAS
• FIRE SPRINK ENERGY T-24MECHANICAL
°= COVER NO,WORK UNTIL ABOVE HAS BEEN SIGNED -HEATING Y!n NE:] NE, `
•- LATH—INTERIOR
ELECTRICAL' FLoo❑zoNE
LATH—EXTERIOR t - FIRE DEPT, v,Q' "� ' Y�_- N❑ '
SHEETROCK GRADE J, FEESUMMARY
SHEAR INTERIOR - BUILDING:I - '„
a I BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLIAN CHECK -
GAS I - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FORINSPECTION BY PHONING 252-.4505, , ELECTRIC
LU P ONE-WORKING DAY BEFORE REQUIRED INSPECTION. ,PLUMBING
0PLEASE GIVE J013ADDRESS\NHE%?"C3% NG,
Z - MECHANICAL '
— SEE PERMITTOR EXPIRATION DATE - _•-
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR:FINAL INSPECTION. TOTAL
OFFICECOPtl
.APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION . PERMIT NUMBER
orulaawc APPLICATION & PERMIT . ICAL `
�, .
'Dun Ess
�,C�.s111 .. + ' �.y L G -ELECTRICAL-PLUMBING-MECHAN ^13654
OWNER'S Iv PLAN CHECK VALIDATION
NAME ; '-� � TY. ELECTRIC PERMIT FEE
PHONJ<
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME � ,`
I �` LIC.No. K LIGHTING FIXTURES 10.00/1.00
CONTRACT NCES-RESIDENTIAL 4.00
ADDRESS L}•�V\ Cv'l
PHONE I NE ^ 10.00 DATE OF APPLICATION
ARCHITECTPAN EL.S• (OVER 20
ENGINEER 0 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
LIC.No. SIGNS TRANS. 3.00 '
ARCO OR ENG: SPECIALCIRCUIT 5,00 PERMIT VALIDATION'
ADDRESS
xir EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS ,-
SERVICE CHANGE 20.00l-
w o o _ LICENSEDCONTRACI'ORS DECLARATION
<u w I hereby affirm that I am licensed under provisions of Clique - =ISSUANCE DATE1
N Q y (commencing wiMRIO
' )of Ulvlsia t fl 'S' - BLDG.I ELECT. PLG. MECH.
F 7 i Professions Co iC .oLicen ass_ m.NumberoODat _ nitractorQ J¢ ¢ ¢ R UBCLARA IO BUILDING PERMIT
s o a ° MISC.- REFER TO ORD INFORMATION
W i�LL I- I hereby affirm that I am exempt from lite Contractor's License - VALUATION $/FT. ,
t- N o j' Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - ,10.00 _
Code:Any city or county which requires a permit to construct,alter,
¢aa < improve,demolish,or repair any Structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. _
0¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TOO -
F-$ he is licensed pursuant to ing provisions of the Contractor's License
i Law(Chapter 9(commencing with Section 7000)of Uivision3of the
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemplion.Any violation of5ection 7031.5 I STORIES TYPE STR.
by any applicant for a permit subjects the applicant toacivilpenalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
❑ I,as owner of the property,or myemployees'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
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.FT.FLOOR AREA TOTALACREAGE
arepts are not hrough
ownemployees,for Sale.
If,however,
the
improve- GAS-EA.SYSTEM-i INC.40UTLETS 6.00
mems are not intended or offered for sale.If,ed that s the building
or improvement 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 Ma. RES IND CON PBOMar
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 ❑' 1:1❑ I,as owner of the property,am exclusively contracting with . . 1:1 ❑.
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to ua owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 `
contracts for such projects with a contrectods)licensed pursuant to A 00ft/10,00
the Contractor's ors License Law. EWER-SANITARY-STORM EA.2TRACT NO. PARCEL N0.
❑ [am exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM •5.00 "
, ACC.GATE" ACC.FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to s Linsure. ZONING
o a certiDc W ker' ompen ion rm ran ,or ells ENG.SITE NO.
3 ). 4 ,(
I �h o
dr-i Co yls here to ed. FIRESPRINK ENERGY T-24
Z Z ❑ Cert 'ed cosy 1 til ith he city inspection division. MISC.- REFER TO ORD.
0 Applicant _ _ ❑ N❑ Y❑ N❑
~ rn PERMIT 10.00
� Cf TIFI OF EX: RGI ROMWORKERS GOOD ZONE A.L.U.C.
LU > AtPENSATION INSURANCE. PLG,CONTR. LIC.NO, PLG.
C (This section teed not be completed if the permit is for one , TOTAL Y❑ N❑ Y❑ N❑
Z hundre dollars 100)or less.),
U O I cert y Ilm m the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is is ed shall not employ any person in any manner so as to
U become su lect to the Workers'Compensation Laws of California.
i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOII CP:TO APPIACANTWf,after making this Certificate of lis.
H Z 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
U such provisions or.this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op00QF.M.) 4.00
CONSTRUCTION Lf;NDING AGENCY AIR HANDLING UNIT(OVER 10AMC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction Icnding agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the walk dor which this permit is issued(Sac. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lend is Na .
Lender's Name
Lender's Address HEATI NG UN IT(OVE R 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
infornmtion-is correct. I agree to comply with all city and county PLUMBING
'� ordinances and state laws relating to building Construction, and BOILER-CO"
H.P.Or 100,000 B,T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,Oo0BTU)SEE FEESCH! 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 CONST.TAX
may in any y accrue against said City in consequence of the PERMIT ISSUANCE 10.00
pal.
. I MECH.CONT. LIC.NO. MECH.
TDTALTOTAL
traclo a e
OFFICE COPY