13593 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PFRMITNWPRER
INSPECTION DIVISION 13593
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDR ESS 20083 MERRTTT DRIVE UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER MATZ CONTRACTOR SUNDANCE IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ssuANw uAT�
MECHANICAL �11raD „ Tec. ELE❑Cr. P^ ME.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Gj{y of IPB IP INFO
ING PERMIT
WOOD FLOOR VALUATION $/FT.
PLUMBING
MECHANICAL -
5 PERMIA y�
ELECTRICAL L
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM
BUILDING USE
NES IND CON PR OIM1er
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
ACC.DATE ACG FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T 24
MECHANICAL I Y ❑ No Y ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C,
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT. v❑ N❑ v ❑ N❑
SHEETROCK GRADE rIRELFEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING •`..
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
�
I OPLEASE GIVE JOB ADDRESS WHEN PHONING.
Z 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
BU LDING PROJECT IDENTIFICATION PERMIT NUMBER
6ILDINcZQOQ3 APPLICATION BE PERMIT 13593
--7C ADDRESS '
UILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
rvnmE QTY- ELECTRIC PERMIT FEE
TZ_ vHON�S 3- �S
CONTRACTOR'SUTLETS-SWETC
HES-RECEP 10.00/1.00
NAME
U ✓Y�d^�C6£ uc.no,y�771� LIGHTINGFIXTURES 0.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDR/ESS �/ [1 -9
/0 >2 E /fJ9/[C./E PHONE J ��'� V PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
TIC,No, SIGNS TRANS. 3.00 _
ARCH.OR ENO. SPECIAL CIRCUIT 5.00 P �^ PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESNr$ MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION CI y e CUpert 7/��
Q u U 1 hereby affirm that 1 am licensed Order proeisim 5 of Chapter 9 $SUANCE DATE
Nay (Commencing with Section 7000)of Division 3 of the Businessand BLDG. ELECT. PLG. MECH.
H N Professions CLpQ�,an my license is in full force armed (f t
z o w Lse CI ss,J` Lhe NumLl
❑
icenber t.1 s s� ❑
0
Date Contractor
a y BUILDING PERMIT
¢ ¢ w OWNER-BUILDER DECLARA'T'ION INFORMATION
w 3 u N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION $/FT.
H LL o a Law for the following reason(Sec.7031.5,Nosiness and Professions PERMIT ISSUANCE 10.00 OD J7
Code:Any city or county which,equinox permit 10conslrucl,alter• ll
QQ Q 20 improve,demolish,Or repair any structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC.
requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant to the provisions ol'the Contractor's License Cs //
Lew(Chtpter9(eommeneingwith Section7000)ofDivision3ol'thc S''0C >Gl �f��
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
I t O STORIES TYPE CONSTR.
¢ H$ the basis for lire alleged exemption.Any violation of Section 7031.5
i by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the properly,or my employees 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 of Offered for otic (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
. property who builds or improve,thereon,and who does such work FIXTURES-PER TRAP 5.011 60.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
.cuts are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-11NC.40UTLETS 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 build or int- RES IND CON Pe Omer
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 properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec. ,B.&P.C.lorthis WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO.
WORKF-RS'COMPFNSA'rION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-ins.re. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec,3800,Lab.C.l.�-�T� Z��s•
Q 'Policy No. Company❑ Certifiedcopy is hereby furnished. Z72Y76-Z FIRE SPRINK ENERGY T 24
Z_ Z� ❑ Certified copy is Filed with the city inspection division. MISC.- REFER TO ORD. y ❑ N❑ Y ❑ N
y ❑
Applicant
F PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU - CERTIFICATEOFEXEMPTION FROM WORKERS'
OJ > COh1PIiNSATION INSURANCE: PLG.CONTR. LIC.No. PLG.
d 0 (This section reed not be completed if the permit is for one TOTAL Y❑ N❑ v [:] N❑
� or Z hundred dollars(8100) less.)
U O I certify that in the performance of the work I'or which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H alit is issued.1 shall not crgd.y any person in tiny nmnner sit as to qq
O w become subject to the Workeri Compensat ion Laws of California. BUILDING
Date Applunat ALTER OR ADD TO MECH. 5.00 --
} 0 N01'ICE TO APPLICANT: If,after making this Certificate of L'x-
F ? emplion,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK L
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 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certity that 1 have read this application tad stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and countyPLUMBING
ordinances and State laws relating to building construction, and BOILER-COMPI3 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 lot inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs d expenses who ch PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accru smut sa' City ons nice of the
grant i of is permit. CH.CONT. LIC.NO. MECH.
TOTAL TOTAL
ignalure o c ntr or Date
OFFICE COPY