14034 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRAIITNUMNER
CITY OF CUPE-RTINO F
INSPECTION DIVISION 14034
1 JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDR ESS
oZ/r-rps fG. 7 Z1&1_�1__UNIT# L0T# -1
• / !J PERMIT EXPIRES IF WORK
• OWNER ��/��� �L✓, CONTRACTOR C7/'\ .,/�J IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT Quc ISSU-
ry1 ^,�__ ANCE OR 180 DAYS FROM
FOUNDATION 1�Ip--g 'r1 LASTCALLED INSPECTION.
LIFER
PREGUNITE n`AyPERMIT VALIDATION
IP
POUR NO CONCREAEETE U BO S ED
UNDERGROUND'/SLAB
PLUMBING
ELECTRICAL WbSLANCE DATE
MECHANICAL ELECT, PLG: MECH.
. E^
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN'SIGNEO BUILDING PERMIT
INFORMATION
WOOD FLOOR - awanoN S/FT.
PLUMBING _ dy
• la
MECHANICAL
ELECTRICAL PERMIT To
FRAMING - 4
STORIES TYPE CONSTR.
INSULATION - J /,
.� OCC.GROUP REFUNITS
had
PLACE NO SUBFLGOR UNTIL ABOVE HAS BEEN SIGNED
_ _ SO.FT FLOOR AREA TOTAL ACREAGE
ROOF 7 ,�
DIAPHRAGM IQ
NUILD USE
HES IND CON
PB- '. Olnw
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - 1 ASSESSORS Elaac0 o. ❑
ROUGH g
PLUMBING / J .R, 6
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
• ELECTRICAL ACC.DATE ACC.FILE NO.
-a�, S IHEATI
NALS j DATE INSP:'
FRAMING ZONING ENO.SITE NO,
INSULATION GFIHESPRINK ENERGY T24
CALM COVER NO WORK UNTIL ABOVE HAS'BEENrSIGNEO FLOOD ZONE A.LU,C.
LATH-INTERIOR CAL
LATH-EXTERIOR !f. FIRE DEPT. Y ". Y N❑
SHEETROCK / GRADE FEESUMMARY
SHEAR INTERIOR BUILDING BUILDING E ..,.�
SHEAR EXTERIOR . re–1 - TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE•
NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED' OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
'ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION.
_ PLUMBING
O
MPLEASE GIVE JOB ADDRESS WHEN PUNIC.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX (� 7
' '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. '
OFFICE COPY
'APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTI FICATION �'-•• PERMIT NUMBER
BUILDINGS APPLICATION & PERMIT
A ' 14 0 3 4
DDRESMILLARD LANE, LOT 12
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
0 PLAN CHECK VALIDATION
NAME GERARD DEVELOPMENTOTY, ELECTRIC PERMIT FEE -
( PHoNE941-414-1
CONTRACTOR
NAME A0�4�,�y OUTLETS-SWITCHES-RECEP 10.00/1.00
?IC.NO. v LIGHTING FIXTURES 10.00/1.00
LIC.rvo.
CONTRACTORS .11 .H�-T APPLIANCES-RESIDENTIAL 4.00
ADDRESS i
LTm PHON I PANELS 10.00 DATE OF APPLICATION
ORRCHIiIici GREG W. BENTON PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER . -
ARCHITECT LIC No,C13629 SIGNS TRANS. 3.00
ARCH,OR 1 EN151 3 MONTEREY AVE. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS '
LOS GATOS, CA. zIP9503 EMP.METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS SEE FEE SCH.
T1�/4�1 'FFTItRs SST+ ST. SERVICE CHANGE - 20.00 1
woo LIWADEeX/WI`k 41RSCA'EAR,YITf31022ayU � y/0
u U I hereby affirm that I am licensed under provisions of Chapter 9 y ISSUANCE DATE
< y (commencing with Section 7000)of Division 3 of the Business and BLDG. I ELECT. I PLG. MECH.
_ F o'^ Professions Code,and my license is in full fore��ss a c e t. I�, �
o Z H o License Class Lic.Number_(r' - � ®_ ta_
Date4_z6�l�Contractor
P x's BUILDING PERMIT
rc w u OWNER-BUILDER DEC TI -
REFERTOORD INFORMATION
F
a f I hereby infirm that 1 am exempt from the ContraClOf s L1cCmse MISC.- VALUATION SIFT.
H a-p Law for the following rcasa,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
N ve Code:Any city orcounty which requires a permit to construct,alter,
p 2¢'o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ` LIC.NO. ELEC. /G O,� / / U ✓ 1e
o - DLL requires the applicant for such permit to file a signed statement that TOTAL(o PERMIT TO
wm w he is licensed pursuant to the provisions of the )ofDivision License
Fz >
Law(Chapter 9(commencingwilh Section 7000)of Uivision3 ofthe .�
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
4 Z D
w. F $ by basis for 0n alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
i ;� by any applicant fora permit subjects the applicant taacivil penalty ALTER-DRAIN IEA.) 5.00 [//
of not mom than five hundred dollars(my em: �. ���/'\
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
(heir sole compensation,will da the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions ' DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ��- 3
Code:The Contractor's License Law does not appply to an owner of
property who builds or improves thereon,and wlro does such work FIXTURES-PER TRAP 5.00 O-- 6Q Fr.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00 . 1yo -7.7
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have file burden of proving that he did not build or no. - . REB IND CON PB Other
prove for 1,as owner
of theJ. INDUSTRIAL WASTE INTER. 30.00 S ❑ ❑ ❑ ❑
❑ d as owner of the property,he exclusively.contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 8.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply /
to an owner of properly who builds or improves Ihercon,and color LAWN SPRINKLERS-OVER 6(EA.) 1.00 6 _�y
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law„ SEWERSANITARY-STORM EA.200ft/10.00 Q � TRA/CT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C,for this WATER HEATER WIVENT - 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconsent to selGinsure,
or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O C� Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z �d Certified cop ed with t1, city, inspection division.
,C a MISC.- REFER TO ORD.
Q pplicant- V ❑ N❑ V❑ N❑
W rn CER IFICATF.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ,¢E
� Z'( This section need not be completed if the permit is for one TOTAL X07 Y❑ N❑ V C] NE]
hundred dollars(S 100)or less.)
0 O 1 certify that in the performance of the work for which this our. 'CITY. +":MECHANICAL PERMIT FEE FEE SUMMARY
IL mit is issued, I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
BUILDING
i Datc Applicant ALTER OR ADD TO MECH. 5.00 (y f0
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex.
F 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
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1000C.FM.) 6.00SEISMIC FEE /3
1 hereby affirm that Ihere'is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00S_
the performance of the work for which this permit is issued(Sec. _ MICROFILM
3097,Civ.C.l. a HEATING UNIT(TO 100,000 B.T.U.) 8.00
.Lender's bl. QO��LT I-� �AT�+-�-+•=�
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
-
• I certify 11,311 have read this application andstore Thal the above VENTILATION FAN (SINGLE) 4.0 - �p
information is correct.I agree to comply with all city enJ county PLUMBING '7/O /
ordinances and slate laws relating to buildinBOI
g construction, and LER-TIIPI3H.P.Dr100,000B.T.U.) 6.00 t�[
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL j /
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. W S
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00 i
-7-
granting of this_p_e MECH.CONT. - LIC.NO. MECH.
f I-?_ev 81 TOTAL �7� TOTAL /3615'
Signature of Applcrost/Contractor Date
OFFICE COPY