15157 (2) POST THIS CARD NEAR FIR OF.BUILDING "
PERMIT NUMBER
ky
CITY OF CUPERTINO
'INSPECTION-DIV ISI OM
JOB INSPECTION•RECORD
PERMIT EXPIRATION
JOB ADDRESS 20896 Jollyman' Lane ' UNIT#k _LOT#
PERMIT EXPIRES IF}WORK
owNER Mr. and Mrs . Muller_ CONTRACTOR - IS NOT STARTED WITHIN.
INSPECTION DATE INSPECTOR ..INSPECTION RECORD 180 DAVS'OF PERMIT ISSU-_:
FOUNDATION . . - , . r _ . . ANCE OR180DAYS�FROM
_ NOTE - ".LASTCALLED INSPECTION.
- UFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED -
TO COMPLY WITH THE APPROVED PLANS AND.CITY'OF PERMIT VALIDATION
PREGUNITE
CUPERTINO STANDARDS a
r GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
UNDERGROUND /SLAB
IGNEDNDERGROUND SLAB
L y
PLUMBING -
ELECTRICAL - ISSUANCE UATE '! r
MECHANICAL I ' - ' SLOG. ELECr. ,. PLG. : MECH,
DO NOT POUR P1 OOR UNTIL ABOVE HAS BEEN SIGNED BUILDING QERMIT'.
`\ INFORM TION
WOOD FLOOR
MPLUMBING - M vnwArlDN T,$ FT.
i p
ECHANICAL I �� /•'�
ELECTRICAL +, - PEHMn TO
-. FRAMING _
STORIES TYPE CONSTR
INSULATION .
,A
OCG GHOUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO,IT,FLOOH AREA TOTAL RCFEAGE
- ROOF ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE .
THE CONSTRUCTION TAX IS PAID
DIAPHRAGM
ROOF SHEATHING , I*S... INeOILDCOON usEPB ,O,I-t
APPLY NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED FINALS "'DATE' INSP. ❑ '❑ ❑ ❑ ❑ t
ASSESSORS PARCEL NO
ROUGH. SAN.N
' - PLUMBING - ELECT.ENERGY
TUBS BSHOWER PAN PLUMBING ENERGY IRAcr No. PARCEL-No.--�
' MECHANICAL - MECH.ENERGY .-
ACC DATE• ACC.FILE N0. .
ELECTRICAL BUILDING ENERGY ,
FRAMING - - ELECT..FINAL TEST
INSULATION
PLUMBING . .ZONING ENG.SITE NO.
GAS TEST - GAS
MECHANICAL FIRE,SPRINK 'ENERGY.T 2G
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING L, ❑'' N❑ ° ❑: N❑
ELECTRICAL RELEASE FLOOD ZONE A.L,Uc.
EXTERIOR SHEAR � - - •
INTERIOR SHEAR FIRE DEPT. Y❑ N❑, y0 N❑,
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH♦ - BUILDI G•
BUILDING
INTERIOR LATH "TEMPORARY APPROVALS
SCRATCH COAT - ELECTRIC _ PLAN CHECK
- GAS ". ,. - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEERSIGNEO OCCUPANCY SEISMIC FEE '
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISS16NED BY BUILDING INSPECTOR. MICROFILM j
' ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELECTRIC r '
`IJ
H -ONE WORKING DAY BEFORE REQUIRED INSPECTION.
V --^
0� PLEP,SE:GIVPLUMBINGE JOB ADDRESS WHEN PHONING, `
= SEE PERMIT FOR EXPIRATION DATE _ MECHANICAL r
IMPORTANT! CONST.TAX" '
PLEASE READ REVERSE SIDE BEFORE r
CALLING FOR FINAL INSPECTION. TOTALn,
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-• - -- BU/'LDING PROJECT IDENTIFICATION - PERMIT NUMBER '.
BUILDING APPLICATION & PERMIT q [1
ADDRESS I �J I J
Q (, BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 1,
OWNER'S - PLAN CHECK VAGI TION'
NAME FEE
j/- TY. ELECTRIC PERMIT / p'G
Iy�� MLILLf/L PHONE2 /� ri ' '1(/ O'✓�
CONTRACTORS OUTLETS:SWITCHES-RECEP 10.00/1.00
WAX
LIGHTING FIXTURES 10.00/1.00
AQOOREss N%pfL;i?,
q PPLIANCES-RESIDENTIAL 4.00
f,ONTRACTOn'S
7 /�,QPHONE Zyy— PANELS 10,00 DATE OF APPLICATION
ARCHITECT w PLAN CHECKFEE.. , s�•P.C.NO.
`
OR - PANELS (OVER 200 AMP) 20.00 1
ENGINEEfl
LIC.NO, SIGNS TRANS. 3.00ARCH OR '
ADDRESS ENG. - SPECIALCIRCUIT 5.00 PERMIT VALIDATION
zm TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH. '' rQ G
ADDRESS` / ; (//!-
V SERVICE CHANGE 20.00
O
02 LICENSED CONTRACTORS UIiCLARATION. '
a u U I bereby'iffirn that I'am licensed under provisions of Chapter 9 F[�rC — O O "� ISSUANCE DATE. '
(Commencing with Section 70001 of Division 3 of the Business and a A p LDG. ELECT. PLG.. MECH,
r n i Professions Cod• and y license is in full for effebi
z o= License Class _ ' Lie.Numbe
o x r w D.h 3' Contract r
a x E KitBUILDING PERMIT
rc a OWNER-BUILDER DECLARATION -
0o a o - - INFORMATION
w ; N I hereby artful that 1 am exempt from the Contractor's License MISC.—, REFER TO ORD
k rcamn.(Sec.7031.5,Business and i'mfessions VALUATION
r=o'a Luw for tllc Ibllowin PERMIT ISSUANCE - a — S/FT.
Code:Any city or county which requires a permit to construct,alter,
K ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. .,LI C.NO.
'ELEC�Ofj /�SQV '
LL requires the applicant for such permit to the a signed statement did , TOTAL 3.2 PERMIT TO
Er
S he is licensed pursuant to the provisions of the Contractor's License ^/' L
rzQ Luw(Chapter 9(commencing with Section 7000)of Division 3 ofthe f((//�'M i'VIC- apo
i z D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE /
M h the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
a3 _ by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN (EA.) 5.00 ^ �
of not more than five hundred dollars($5001.): -
❑ I,as owner of IhelProperl y,or my employees with wages as BACK FLOW PROTECT. DEVICE .4.OB Z�. OCC.GROUP "RES.UNITS
their sole eonnpensllion,will do the work,and the structure Is not
intended or offered Ibr sale (sec. 7044, Ilusmess and Professions DRAINS-FLOOR,ROOF,AREA,COND. 3-30 �-
Code:The Contractor's License Law does not apply fo an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
r mems are not intended or offered for sale.If,however,lite building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 J.
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 lie did not build or im.with
1,as owner RES IND CON '� PB Omer
❑ I,as o
prove purpose oof sale.). INDUSTRIAL WASTE INTER. 30.00 ❑' ❑i '❑ ❑,, 1:1' l'the property,,um exclusively mnfrucling
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 i License Law'does not apply
to an owner of propertywhobuilds or improves thereon,and who LAWN SPR INKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contraclood,licensed pursuant to SEWER-SANITARY-STORM EA.200it/10.00
the Contractor's License Law. . TRACT NO. PARCEL NO.
❑ lam exempt under Sec..,L&P.C.for This
reason WATER HEATER W/VENT .6.00 _
_ . .
Owner Date WATER SYSTEM •5:00 ACC.DATE ACC.FILE NO.
�� �
WORKI:RS'C MPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby ullinn
that ljhaveacertificutc uLconsenl to self-insum, _ .ZONING ENG.SITE NO.
or a ertificate of Workers.ConiaQxaiion Insurance,or a edified - ,
Copy cut(Sec.3800,L miC.)L1 R-'eeA r,,n y *I
Policy No. Cornpany:L(/S•_2t=y'.4 - -
❑ Cetlilicd copy is hereby furnished. .FIRESPRINK ENERGY Tt14
Z Z AppB�Celti - npy . led with city inspection division. MISC.- REFER TO ORD. v N v N
O ❑ ❑ ❑ ❑
~ rn - PERMIT ISSUANCE —10:00 FLOOD ZONE t A.L.u.c.
CGRTI FICA'1'1:OF EXP,MP ON PROM WORKERS' a1.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. . PLG. ) _
CL 0 (This section need not he completed! it'the permit is for one TOTAL•Ot d 0 Y❑ N❑ Y❑ "N❑
:�-) 2 hundred dollars(S I00)Orless,)
U O 1-certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY '
LL F mit is issued,I shall not employ any person in any manner so as to '
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /
} W NOTICE TO APPLICANT: If,after making this Certificate of fix- _
♦— 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 he deemed revoked. AIR HANDLING UNIT(TO IOPMC.F.M.) 4.00
CONS'T'RUCTION LENDING AC17NCY AIR HANDLING UNIT(OVER 10=C.EM.),6.00 SEISMIC FEE
P hereby affirm that there is a construction lending agency tar 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.) 6.00
Leader's Num. EAI G UN IT IOV ER 100,000 B.T.U.)9.50
• Lender's AddressS- H TN
ELECTRIC 3a �-
1 certify that 1 have read this application amd state that the above VENTILATION FAN (SINGLE), '4.00 _
information is correct. I agree to comply with all city and county ,BOILER-COA4P I3 H.P.of 100,000 BrT:U.), 6.00 PLUMBING a !
ordinances and state laws relating to holding construction, and J a
hereby authurive representulives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)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 PERMITISSUANCE 1800 /Y. CONST.TAX
ay in any way accrue against said City in consequence of the
molt of this permit. MECH.CONT. - LIC.NO. MECH.
S/old TOTALa ��' TOTAL
S' nature of pplican GCo tot Dale /
OFFICE COPY