13939 (2) POST THIS CARD NEAR FRONT OF BUILDING
PER M1fIi NUMBER
CITY OF CUPERTINO 13939
INSPECTION DIVISION
` JOB INSPECTION RECORD
}J1 PERMIT EXPIRATION
F� •ri JOBADDRESS 10695 MERRIMAN ROAD UNIT# LOT#
PEREZ, DON DON PEREZ PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREG UNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /
UNDERGROUND /SLAB
PLUMBING
ELECTRIC L ISSUA NCE DATE
BLDG. ELECT. I PLG. NECK
MECHANICAL ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING
MECHANICAL PERMIT To
ELECTRICAL
I
FRAMING
STORIES TYPE CONSTR.
INSULATION
OC-GROUP RES.UNITS
PLACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING use
RES IND CON PB 011111
El El
1 t
` APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORPARCEL O. El
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACL DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY TZa
MECHANICAL Y [] NED v ❑ NE-]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. `'E] N� V ❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC FEE
PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
` '✓ PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
J
I IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL �O
CALLING FOR FINAL INSPECTION.
OFFICE COPY
"qq*.IA?PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LOI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUI°L�DING APPLICATION & PERMIT 13939
A VE BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
Dix R'S ^ PLAN CHECK VALIDATION
"A L� !�p QTY. ELECTRIC PERMIT FEE
') <�,�. dworJf o12 X00
j NAArvTRACTO OUTLETS-SWITCHES-RECEP 10.00/1.00
�y LIC.No. LIGHTING FIXTURES 10.00/1.00
f,ONTRACTO ' APPLIANCES-RESIDENTIAL 4.00
ADDHEas
PROrvFL/C y PANELS 10.00 DATE OF APPLICATION
ARCHITECT ^ ( PANELS IDV ER 200 AMP) 20,00 PLAN CHECKFEE P.C.NO.
OR V-
ENGINEER
LIC,NO, SIGNS TRANS. 3.00
ARCH.OR ENG. S
P 5.00 PERMIT VALIDATION
ADDRESS PECIAL CIRCUIT
1 EMP.METER OR POLE INS. 20.00
APPLICANTS IMOTORS SEE FEE SCH. C
ADDRESS
SERVICE CHANGE 20.00
o¢
/
LICENSED CONTRACTORS UHCLARATION
<l j� emby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H ` ,mencing with Section 7000)of Division 3 0(the Business and BLDG. ELECT. PLG. MECH.
lessiom,Cod and my license is in full for�ce,�W fdo t
Z o v 'icen Class 1 I Lie Number LJ '+ 9 ❑ ❑ ❑ ❑
o D Uate ...$'^ Contramor
a y BUILDING PERMIT
L ¢ OWNER-BUILDER DECLARATION INFORMATION
w 3 '0
vHi I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
o ¢ Law forth,followingrcusoa(Sec.7031.5,Businessand Professions VALUATION $/FT.
E y Code:Any coolish coo my which reqstructureela,
permit prior
is issuance,
,also
MRM 10.00
¢Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. TOTAL
0¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m LL he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 of the TAREATOTAL
- a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
ce TORIEONSTR.
¢ I_ o thebasisfor the all,g,d exemption.Any violation ofSeclion703L5aby any'applicant for a permit subjects the applicantto a civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00
ofnot more than five hundred dollurs(8500).1:❑ I,us owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GRONITS
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:Tile 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 SOFT.FLOOCREAGE
himself or through his own employees.provided that suchmimprmvo GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
mes are not intended or offered for sale.11;however,the building
or improvement is sold within one year of completion,the own,r- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving thin he did out build Or int- REB IND CON PB Diner
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,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:'1'he Contractors License Law does not apply
to an owner Of property who builds or inphmvcs thereon,and whogWATERSTREATING
N SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmetu ls)licensed pursuant In =EQUIP.
EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL N0.
❑ lam exempt under Sec.-,BAP.C.for this 6.00
reason
Owner Date 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION D17CLARATION . 5.00I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG,SITE NO.
or a eciflicate of Workers'Compensation Insurance,or a refilled
copy thereof(See.3800,Lab.C.L
Policy No. Company`"
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certifh,d copy is fled will, the oily inspection division. MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N❑
O Applicant
y CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AL. .O.
QJ > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑
CL 0 fThis xclidn need not be completed if the permit is for one TOTAL
0 Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
O0 become subject to the W'orkers''Compen,t6,m LawSof California. BUILDING
On nate Applicant ALTER OR ADD TO MECH. 5.00
} tray NOTICE 1'0 APPLICANT: If,after making this Certificate of Ex
F 2 emptice,you should become subject to the Workers'Compensation APPLIANCEPLAN CHECK
provisions of the Labor Code, you most lulthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0=C.F.M.) 6.00 SEISMIC FEE
I 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. HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM
3097.Civ.C.).
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I aertily that l have read this'application and state Chat the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and manly BOILER-COMP(3 H.P,or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
` ) hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
r (We) agree to save, indemnify and keep harniless the Cily of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expense$wlhidh PERMIT ISSUANCE 10,00 CONST.TAX
may in any way accrue against Said City in consequence of the
granting of this permit MECH.CONT. LIC.NO, MECH.
TOTAL t' 6
TOTAL 6)
Sigmture of ApplivmUC'ontraclor Date
OFFICE COPY
. B
AfCupert ' no Cl Y U
N VI R
omm ?19 MIT
NO. FEE ,Zd,2°
Notice is hereby given by the City of Cupertino that an Application
for House Moving Permit has duly Been filed in the Building I pecto_r's
Office for the ovin of a buildin from 0;�,
0
•; No. Street Lot Block —JUra—al City - —
To:
�N� I Street I Lot � Block , � Tract Cityr�
Applicant ---------- ---------•--... ------.... ---------------- .................I.........
Address �rC�-- ----------------------------------
-5'7/
Contractor .: .� �:.................. Address .(3L.�`,�� R� I
State License ./,�-.-9,g `�
---------- .......
Phone
h,�w -; 'a D A P°4 l • l?�.� f- g �J BY G�..... ..� ,/
CHIEF BUILDING INSPECTOR
POST THIS FORM ON BUILDING