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13964 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER . J . CITY OF CUPERTINO 13964 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 21070 MANITA COURT -UNIT LOT# PERMIT EXPIRES IF WORK OWNER ART ROUSER CONTRACTOR LUNA SWIMMING POOLS IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS O0PERMIT ISSU- FOUNDATION ANCE OR 180,DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE 7.3- PERMIT VALIDATION OL ~, POUR N((/CONCRETE UNTIL ABOVE HAS BEEN SIGNED (/ UNDERGROUND /SLAB PLUMBING �1 ELECTRICAL �/ . Pol--IV$DANCE DATE'. MECHANICAL yR, -BLDG: ELECT. PLG. MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL PERMIT TO ELECTRICAL ; I FRAMING , 1 STORIES TYPE CONSTR. INSULATION _ - OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FL FLOOR AREP TOTAL ACREAGE ROOF DIAPHRAGM BUILDING,USE RES IND CON PB Utlrci APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El El ❑ ❑ ASSESSORS PARCEL NO. ROUGH l PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ' ACC.DATE ACC.FILE NO. ' ELECTRICAL FINALS DATE INSP. _ FRAMING SAN # ZONING ENG,SITE NO. INSULATIONPLUMBING0�. ?. GAS p06 '-S. jFjr W6 FIRE SPRINK ENERGY L]0 MECHANICAL Y ❑ No Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING pog F LOOD ZONE AT.U.C, LATH—INTERIOR ELECTRICAL pL LATH—EXTERIOR FIRE DEPT. Y❑ N❑ v ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING OC I 9-5--rirBUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLANCHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1 OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 1 LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING h� z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAX IMPORTANT! 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 BUILDING PROJECT IDENTIFICATION PERMIT NUMBER au, , APPLICATION & PERMIT 13964 • ADDRESS • f,/07C.� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER. PLAN CHECK VALIDATION NAME- OTY. ELECTRIC PERMIT FEE PHONE W , corvrRAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 NAME y/i 4..•;,. - uc.rvo. SLIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. DR 9 i< ENGINEER O L.C.NO. SIGNS TRANS. 3,00 ARCH.OR ENG. 5.00 PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT ZIP TEMP.METER OR POLE INS. 20.00 nooAe srS MOTORS SEE FEE SCH. ..1 SERVICE CHANGE 20.00 x - wO o LICENSED CONTRACTORS DECLARATION < U v I hereby affirm that I am licensed under provisions of Chapter 9 fxll ISSUANCE DATE H z it (commencing with Section 7000)of Divisiml 3 of the Business and ,BLOG. - ELECT. PLG. MECH. H N z Professions Code,and my license is in full for and eff;cL� �] z O a - License Class / {K Lic.Numbu �}t �f_ O H ° Date 4# Contractor L(efi�� rr,rp^')'(\C`� BUILDING PERMIT w ¢ OWNER-BUILDER D17CLARATION 'a H INFORMATION u X a y I hereby affirm that 1 um exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT. Huoa Law for the followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 .G- Code:Any city or county which requires a permit to construct,alter, u<G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. - O M requires the applicant for such permit to file a signed statement that TOTAL iJ v MIT TO w $ he is licensed pursuant to the provisions of the Contractor's License H z i Law(Chapter 9(commencing with Section 7000)oCDivision3 of the a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE r O the basis for the alleged exemption.Any violation of Section 7031.5 STORI S TYPE CONSTR. i ;� by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 9-V It,of not more than five hundred dollars(S500),I: O I,as owner of the property,or my employees with wages as ggCK F LOW PROTECT. DEVICE 4.00 Dec.GROUP RES.UNITS v 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 S.OU 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meets are nolintended moffered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 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 buil)or im" RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ Licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASS45SORS PARCEL NO. and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon.and who ILAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a conlractons)licensed pursuant to SEWER-SANITAV-STORM EA.200ft/10.00 TRACT NO. PARCEL N0. the Contractor's License Law. R ❑ lam exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM -I-A, 1 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ^\�D•``a ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a.certified copy thereof Se 38 .L b.S!WI .�:ij.0 Policy No, - O O Cetlihed Copy is hereby n' d. . FIRE SPRINK ENERGY TY4 Z Z ❑ Certified co fifJi1ed he city inspection division. MISC.- REFER TO ORD. y ❑ N❑ v ❑ N❑ NApplicanta�v .- - CERT CAT F EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. DJ > COMPENSATION INSURANCE PLG.CONTR. LIC NO. PLG. aQ TOTAL D � Y❑ N❑ V❑ IN E] (This section need not be completed if the permit is for one 0 Z hundred dollars(S 100)or less) U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL H 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. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } y NOTICE.TO APPLICANT: If,after nm king this Certificate of I!x- F Z emption,you should become subject to the Workers'Compensation APPLIANCE -5.b0 PLAN CHECK --ra provisions of the Labor Code, you must forthwith comply with FEE Spr• V such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.)- 4.00 / CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE ( S 1 hereby affirm that there is a construction lending agency for 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.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address • 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 / A„Ca information is correct.1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby aulhorite representatives of this city to enter upon the BOILER-COMP (over 100,000BTU)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,just nts, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue again 55id City m consequence of the granting of this permit. MECH.CONT. LIQ NO. MECH. OTALTOTAL as-- .Signal-.VX ut ontrpctor - Date OFFICE COPY