12993 (3) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PE
RNil T ND ,BER
INSPECTION DIVISION 12993
JOB INSPECTION RECORD
•
JOBADDRESS 10062 MILLER AVENUE UNIT# Lor# PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
OWNER HOME FEDERAL SAVINGS,ONTRACTOR JOHANSON CONST. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSUti
FOUNDATION ANCE OR 180 DAYS'FROM
UFER LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
� ISSUANCE DA'i E
MECHANICAL ELECT. PLG. MECH.
'-0 El 0 LEI,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOORINFORMATION
PLUMBING • VALUATION $/FT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING - - - --
INSULATION STORIES TYPE CONSTR.
(Tc c.GROUP ARES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• =ABOVE
SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB ORiei
APPLY NO ❑ ❑ ❑ ❑ ••❑
ASSESSO SPARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
INSULATION PLUMBING O J3,87 ZONING ENG,SITE NO.
GAS
MECHANICAL D� 3-�7 EFIRE SPRINK ENERGY T.aa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ V ❑ "❑LATH-INTERIOR ELECTRICAL Oma$�7 OOZONE A.L.U.C.
LATH-EXTERIOR FIREDEPT. ❑ "❑ Y ❑ N❑
SHEETROCK =OCCUPANCY
FEESUMMARY
SHEAR INTERIOR
SHEAR EXTERIOR APPROVALS BUILDING
FIREWALLS PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BI I SEISMIC FEE
UCCUPANCV OF BUILDING IS NOT PERR'11TTEO UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR
MICROFILM
— ' w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
•' 0 ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB PLUMBING
ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE '}a
SIDE BEFORE ?i 4,, , , TOTAL
CALLING FOR FINAL INSPECTION.
APPLICAN-i TO FILL IN INFOR114.Ol iON VVITI-IIN RED LINES - USE PALL POINT PE'IU ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
GDILDING APPLICATION & PERMIT
ADDRESS 12993
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
..NEH'S I PLAN CHECK VALIDATION
na E
N .EOTY, ELECTRIC PERMIT FEE
A
E
"'.• Rac osi
ss - �I UTLETS-SWITCHES-RECEP 10.00/1.00
_Z!`&#W60V LIGHTING FIXTURES 10,00/1.00
'41I I;UNFMAADDREaG1DF5 PPLIANCES-RESIDENTIAL 4.00
MAIH rve PANELS 10.00 (J BATE OF APPLICATION
ORcNrtECT I, • PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER 94N ,
LIC.eO. SIGNS TRANS. 3.00
ADDRESS ENO' SPECIAL CIRCUIT 5.00 _ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS Ts MOTORS SEE FEE SCH. r/n
SERVICE CHANGE 7 ? - 20.00
,30 2 /
>, o LICENSED CONTRACTORS DECLARATION G�
�
a se W I hereby affirm that Ian,licensed under provisions of Chapter 9 �
2 ISSUANCE DATE
(commencing wit ecti0n 7000)of Uivisims 3 of the Business unJ
N i Plu lBsslmss Cole d my license is in(all fur If a9 - BLDG. ELECT. PLG. M H.
o i y.o License�QJ ss Lic.Nun,bc _ I(/ I� '
a w S j , Date.�•A��_,p._ Contractor - 1 Lbs.
✓✓ O'/7- BUILDING PERMIT
IE a ¢ OW hN'R-IIUILUIiR DL f� �;� �: •�
0... MISC.- REFER TO ORD - INFORMATION
E
; I hereby affirm Ilsul I am o%Erse Pl frons c CWdracloi s LIL'm1IC VALUATION S/FT.
F u. oQ Law for following reason.(Sec.7031.S,Businessland l'milesumn, PERMIT ISSUANCE -�l
9 �>f Code:Any City or county which fsquircsaPon nil 11 COnsleCl,ul(eq 1B.BD /S VV
neimprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.
S ¢ °
ELEC.
n a °o u requires IhC applicu0/fOf such permit to file a signet Slalnnenl that TOTAL
w m n he is licensed pursuant to the provisions of the Contnmtoi s License _ PERMIT TO
ri >
Low(Chapter 9(commencingwilhSection 7000)ufUivision3ofthe
1 q c Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
(CV- p the basis for the alleged exemption.Any violation of Section 7031.5 - - - STORIES TYPE CONSTR.
nim
by any applicant for at Idle subjects $50U)'). tuucivil rcnalty ALTER -DRAIN 5.00
of no[nee than five hundred dollen Imy employees
❑ [.as owner of the property,at my ampluyess 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 or offered (or sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlractnr i License Law does not apply to an owner of
properly who builds or improves thereon,and who docs such work -FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,Provided that such in)]eve
menuare not intended oroffered fussed,If,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within este year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of Proving tire[he did 1101 build or art- BUILDING USE
(prove for purpose ul'suleJ' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB amt,
❑ d:u owner uf.trss',EIRnl um eroject(Sol.s7 Nacl Ing wish 1] ❑ ❑ 0 11
licensed coimis od m co Color1 the pw"n (Sol. does of app]
LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Frowner in pole:ty Con techs i License Law dues not apply
no contracts owner o1'property who builds nr improves Ihcaun.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
the Contsur wch projects with a ronlructonsl licensed pmsuam to
the 1unt see License Law. SEWER-SAN ITARV-STORM EA:200ftl10.00 ( TRACT NO. PARCEL NO.
❑ lam exempt under Sec...BAP.C.I'or this
fCi1S011 WATER HEATER W/VENT 6.00 I
Owner Date WATER SYSTEM .. 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby aflinn thin I have a L'cRifi,mc nI ouse ll IO ICICI nfnfe.
or a cvnifieale of Workers'Compensation Ifnurunce,or a certified ZONING ENG.SITE NO.
copy Ihereut(Sec.3800,rah.('.).
Policy Nn.40M!qzi'�'NISATION
_Cmnp:uly- �'�_."l�
O ❑ Ca•rnis cby fumisheJ�/✓ysWG-CN/ yp FIRE SPHINK ENERGY T-24
Z Z )If� Cerl y led with Ih�e city il1cliun� un. Y N Y No
FIn
O'� Apallcan� �^+�. MISC.- REFER TO ORD.
// PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
cc CE OFRntdrriON FROM WORKERS'
LU MPENSATION INSURANCE PLG,CONTR. LIC.No. PLO. p .�' y N Y ❑ N0
CL O (This section stood not be completed if the permit is for one TOTAL
Z hundred dollan($100)or less.)
U O I certify that in the performance of the work for which This per. OTV MECHANICAL PERMIT FEB;, FEE SUMMARY
0 U mil is issued,I shall not employ any Person in any manner so as to _ ,� �- „ -
become subject Io the Workers Cumpcnm(iun Laws of California.
O y Dane ICANI': I ALTER OR ADD TO MECH. 5.00 f� BUILDING a
} 2 NOTICE TO APPLICANT': If,a0cr making this rs'C Mase o1'Iix-
F _ emPiun,sion You shouldbecomeCode,
to the Wntwii Ccogply with APPLIANCE 5.00 PLAN CHECK
such
previsions of the Labor Code, you muss forthwith comply with FEE
L.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT OVER 10XIC.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) % ('•5.00
the perl' mim ormof the work for which()its permit is issued ISec. MICROFILM
3097,Cie.C.l. HEATING UNIT(TO 100,000
Lender's Name
"-\ Lenders Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 I ELECTRIC
• I corny that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
inf0nnotion
is correct. I agree to comply with all city and county PLUMBING �1
ordinances used slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 �I
hereby auIhentiorid roperty fur insvcs of this city I. enter upon the BOILER-COMP Weor 100,000 BTU)SEE FEE SCH. MECHANICAL Sa'L
above-mentioned ProPCrty fur inspection purposes.I..
(We a ec to Sr e, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cope, it aguins bililies,judgments, 1111, and expenses which CONST.TAX
may it ny w -rue against Said City in consequence of the PERMIT ISSUANCE 10.00ol
Or (i o1'1 , n I. MECH.CONT. LIC.NO. MECH. �'1 �t 6
TOTAL ' -_ �✓
' II, talc-- TOTAL of-