14566 (2) POST•,THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER ,.
' 'CITY 01 =CUPERTINO' X566: :.
INSPECTION DIVISION
L ' JOB INSPECTION RECORD • - ,
}
PERMIT'EXPI RATION
' .JOB ADDRESS 10526 •Lo,nna' ..Lane'. _LOT# 'i
PERMIT EXPIRES IF WORK•' '
OWNERJim,.Lent'feT „-CONTRACTOR IS,'NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD lk DAYS OFPEAMIT IssU-
FOUNDATION - NOTE: I ANCE OR 180'DAVS FROM
- LASiCALLEDI NSiECTION.
UFER - ALL GRADING ANDIDRAINAGE SHALL BE INSTALLED .�
PREGUN ITE : TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAL-IDATION
CUP.ERTINO STANDARDS. -
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'. _
UNDERGROUND /SLAB
_• PLUMBING - _ ' � '® P. �i� �(�L{
ELECTRICAL ' < - -� ISSUANCE DATE
MECHANICAL BL_OECT.I vLG MECH.;.�,�
❑._ ..
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDING PERMIT.
Co
`',� mIRMATION"l-,
WOOD FLOOR VALUATION" VITT.
PLUMBINGn. e .
MECHANICAL
ELECTRICAL
PEH ITTO -'.
FRAMING
INSULATION '' - -' STORIES TYPE c NSTR_
.. -e
OCC.GROUP • RESUNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO FT,FLOOR AREA TOTAL ACREAGE
N FINAL INSP.SHALL BE MADE R E ' -
ROOF NOTE: 0 BEFO E
DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID a -
i BUILDING USE
ROOF SHEATHING - - -RCS' -.IND CON - PB A OW,, i
'APPLY NO ROOFING,UNTIL ABOVE'HAS BEEN SIGNED, FINALS, DATE INSP.;,' ❑ �
.ASSESSORSSPP ARCEL NO.
• ROUGH SAN.#
PLUMBING ELECT.ENERGY - •''
TUBS&SHOWER PAN ; PLUMBING ENERGY HAcr No. PARCEL,No
MECHANICAL MECH.ENERGY,
ELECTRICAL, BUILDING ENERGY" -- A,CC.DATE Acc PILE NO.
• - FRAMING - - ELECT.-FINAL TEST ZONING ENG.SITE No
INSULATION : PLUMBING ,• - - `
GAS TEST GAS - -
b - FIRE'SPRINK ENERGY T24
• .: MECHANICAL 1 Y01 T.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING'. Y j' N�,
FLOOD ZONE A L u.c.
' EXTERIOR SHEAR ELECTRICAL RELEASE - - i
.INTERIOR-SHEAR FIRE DEPT. - - v'�, '"�' Y L_ No;
SHEETROCK GRADE FEE SUMMARY
EXTERIOR rLATH BUILDING RECTRIC INTERIOR LATH - TEMPORARY APPROVALS 'SCRATCH COAT ELECTRIC - CK
GASNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY EE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. M
ARRANGE FOR INSPECTION BY PHONING 252-4505
LU ONE'WORKING DAY BEFORE REQUIRED INSPECTION
• Y H" PLUMBING .TM 1
o� PLEASE GIVE JOB 'ADDRESS WHEN PHONING. "
�MECHI
—, S EE,P ERMIT FO.R EXPO RATIONI DATE =
IMPORT1.ANTI'. ' coNST rax '
PLEASE'READ REVERSE SIDE BEFORE. ° t
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE,COP.V
APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION PERMIT NOMBER
A80 L
DDRESS APPLICATION & PERMIT A p"� n
•✓ AOpRESa Vr ` I L� b
' & LANE- W la ILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NA E
I''aA1 DTV. ELECTRIC PERMIT FEE
HAC ORS PHONE
NAMERAcroRs UTLETS-•SWITCHES-RECEP 10.00/1.00 -
.LIC,NO.' .LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
TE55 - APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS , 10.00 DATE OF APPLICATION
ORCwTECT_ PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. - 3.00
ARCH.Or ENG. PERMIT VALIDATION i
ADDRESS SPECIALCIRCUIT 5.00
ZIP rrEMP.METER OR POLE INS. 20.00 -
APPLICANT'S - - S.
ADDRESS _ MOTORS SEE FEE SCH. Pod .
SERVICE CHANGE 20.00 /0 0
O'O. LICENSEDCONTRACTORS DECLARATION O
a U U I hereby affirm that 1 am licensed under provisions of Chapter 9 N ISSUANCE DATE
vFi 1 w (commencing with Section 7000)of Division 3 of the Business and PLG. MECH.
F n i BLDG.Professions Code,and my license is.hl full force and effect. - BLDG ❑
o0 W License Class Lic.Number i�YI1KW-r
F m J Date Contractor
BUILDING PERMIT
Ic ¢ a OWNER-BUILDER DFCLARA'I'ION
¢0 d D.' " INFORMATION
w ; w I hereby affirm that I am exempt from the Contractor's License MISC.-' REFER TO ORD
Foo J Law for the following reason.(Sec.]031.5,Business and Professions PERMIT ISSUANCE 10.00 C� VALUATION S/FT.
Code Any City or county which requiresa Permit to Construct,alter,
2 Q-4 20 improve;demolish,or repair any structure,Prior to its issuance,also ELEC.CONTR. , LIC.NO-• ELED. s \ /�
n wO u requires the applicant lot such permit to file a signed statement that TOTAL cp. PERMIT TO
$ he is licensed pursuant to the provisions of the Contractor's License
La.(Chapter 9(commencing with Section 7000)of Division 3 oftheIN 7ZQC0R 0
a Business and Professions Coda)or that he is exempt therefrom atilt OTY. PLUMBING PERMIT FEE'
r$ the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES .TYPE CONSTR.
by any applicant for a permit subjects the applicartoacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
` O I,as owner of-the property,or my employees with wages as BACK FLOW PROTECT.DEVICE - 4.00 Oce.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 50.'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-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, Rhe owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proviog,that he did not build or im RES IRO CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ 1 am exempt unde cc. ,B.&P.C.for this WATER HEATER W/VENT 6.00
" reason
Owner- Date 14 WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
6/wORKERS'COMPEN ATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to sell-insure,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO.
copy thereof(Sce.3800,Lab C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z ZO. ❑ Certified copy is filed with.the city inspection division. MISC.- REFER TO ORD. ❑ N❑ ❑Y N❑
Applicant Y '
~ w - - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
UJ CERTIFICATE E SATION INS FROM WORKIiRS"
' W � COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG. '
CL O This section need not he completed if the permit is for one TOTAL Y❑ N❑ 1 Y ❑ N❑
-'=) Z- hundred dollars(S 100)or less.)
U•O I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued,I shall not employ any person in any manner so as to -
U become subject to the Workers'Compensation Laws of California. P{p
U i Date ' ApplicantALTER OR ADD TO MECH. 5.00 BUILDING /Q
} to NOTICE TO'APPLICANT: If,after making this Certificate of E.-
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, yea.musl forthwith comply with AIR HANDLING UNIT(TO 10 FEE
ch provisions or this permit shall be deemed revoked.
U su ,000QF.M.) 4.00
CONSTRUCTION LENDING ACBNCY AIR HANDLING UNIT(OVER 10000.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lendlnslp,ygency I'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is Issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CivCJ.
s. Lender's Name ,HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address'
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
I- •�
information is Correct. I agree to comply with all city and county PLUMBING ,
t ordinances and state laws relating to building construction, and BOILER-COMM H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 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 ciipenses which CONST:TAX
ay any way ace e_agains said City in consequence of the PERMIT ISSUANCE 10.00
rant' of this per ' . MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Winne of p cant/Con actor -Dale - -
OFFICE COPY