15225 (2) POST THIS CARD NEAR•FRONT OF BUILDING' "
r: • '� :PERMIT NUMBER I
=CITY "OF' .CUPERTINO 15225 ! "
,',, • • ' r', ' '+ INSPECTION,DIVISION''
JOB INSPECTION RECORD
".* ? PERMIT EXPIRATION .
+' JOB�ADDRESS 10095 Orange Avenue UNIT# _LOT#
- PERMIT EXPI R ES�IF WORK,?
OWNER .:Wal+ter''&'"Barbara .,Weintz CONTRACTOR - IS,NOTSTARTED WITHIN
INSPECTION - DATE INSPECTOR INSPECTION RECORD 160 DAYS OF PERMIT ISSU- '
FOUNDATION - ANCE�OR 180 DAYS FROM
NOTE: . LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED ' \
PREGUNITE "- TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATIOIN '
CUPERTINO STANDARDS. - �\
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - %•'+ ='-� >
UNDERGROUND /,SLAB. . -'
PLUMBING
ELECTRICAL " - ISSUANCL OA TE
MECHANICAL, BLDGELECT, PLG. MED+,
.. DO NOT POUR.FLOOR UNTIL ABOVE HAS BEEN SIGNEDn q 1 ® BINFORMATION MILDING T
-WOOD FLOOR W JIB f .VALUATION - s+E T:
PLUMBINGCu 0
' MECHANICAL
PER Mn.rD .
• ` ELECTRICAL'' +'. a,\ ,Q�a&:
FRAMING'
STORIf.S TYPE"CONSTR.
INSULATION
OCC.GROUP. RES.UNITS
i
PLACE NO.SUBFL'OOR UNTIL ABOVE HAS BEEN SIGNED ',x' ''• ''+ '
F 1�f L OD11 AREA IOTAI.ACR1.Al:1
ROOF.' NOTE:NO FINAL INSP:SHALL BE MADE BEFORE "
DIAPHRAGM - - -
THE CONSTRUCTION TAX IS PAID
. - BUILDING USE
ROOF SHEATHING ' Nes IND .coN Pe '� D...11 11 El I
,, "
APPLY NO.ROOFING UNTIL ABOVE HAS-BEEN SIGNED (FINALS DATE'. INSP. 1:1 El -•
ASSESSORS PARCEL No,
ROUGH- - SAN,h '::,'•.'
PLUMBING - ELECT.ENERGY
TNnCI NO. , . .PARCEL NO '
' TUBS 8 SHOWER PAN, PLUMBING ENERGY
MECHANICAL ' MECH.ENERGY
ELECTRICAL _ ACC:DATE ACC.FILE NO.
'BUILDING.ENERGY
_ ELECTFINAL TEST
FRAMING . ZONING•l. 'ENG.SITE-NO. .
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL ' FINE SPRINK ENERGY T 2a
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED "HEATING, v NE] Y E) N❑
EXTERIOR SHEAR' ELECTRICAL RELEASE - rLooD zorve .A.L,u.c..
INTERIOR SHEAR " - - FIRE DEPT. - C'❑ ,N❑' ❑ N❑
SHEETROCK:•, GRADE .'• FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING '
INTERIOR LATH TEMPORARY APPROVALS-
SCRATCH' COAT - ELECTRIC PLAN CHECK
„ GAS .FEE:
•• NO TAPE.OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE `
OCCUPANCYOF BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM f
ARRANGE FOR INSPECTION BY•PHONING 252-4505, ELeCTRIC
o� ONE WORKING-DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING., r
z - — SEE,P,ERMIT'FOR EXPIRATION DATE— MECHANICAL.
'
IMPORTANT!' coNsr.TAX
" .i PLEASE READ REVERSE SIDE BEFORE,..
•"CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN-INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' '13UI LDI NG PROJECTA DENTI FI CATION - PERMIT NUMBER_- ,
BUILDING APPLICATION & PERMIT 52'2
ADDRESS /� I 5
I
r'/• S vi / ,P BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
NO� IsA i .� / (f &) PLAN CHECK VALIDATION
VA(
r
QTY. ELECTRIC PERMIT FEE
W— 'PHONE
FnMERACToas UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. LIGHTING FIXTURES' ' 10.00/1.00 "
CONTRACTORS - . . APPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION'
ARCHITECT T.PLAN CHECK FEE _P.C_NO.
OR PANELS (OVER 200 AMP) 20.00 _
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH,OR ENG. - PERMIT VALIDATION
ADDRESS L SPECIAL CIRCUIT '. 5.00 -
-ZIP frEMP.METER OR POLE INS. 20.00
APPLICANTMOTORS SEE FEE SCH.`
ADDRESSSS
SERVICE CHANGE 20.00In V '/ C� ,
S:o LICENSED CON I"RACfORS DECLARATION S/ .��lo Q
4 v u I hereby al'finn that I ren licensed under pnrvisiuus of Chnpler'l 1&555//LANCE GATE :
H Z w (commencing with Section 7000)of Division 3111 the FrAmen and - - BLDG. ELECT. PLG. MECH.
H n z• Professions Code,and my license is in full force and effect ❑ ❑ ❑
z — License Class Lic.Number -
g mo m H w Date—Contractor '
F y s BUILDING PERMIT
Ic ¢
IS < OWNER-BUILDER DECLARATION - INFORMATION
E:
3°' H 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u O¢'.• Law for Ilse following VALUATION SOFT.
- F — sreuson.(Sce.7031.5,Busincssand Prolessions PERMIT ISSUANCE 10.00
IAS Code:Any city or county which requiresa Pennit tOcnnstraot,alteq -
¢ ¢ ¢ improve,demolish,or ripuir any structure,prior m its issuance,"also ELEC.CONTR. LIC.NO. ELEC.
—.O u requires the applicant for such permit to file a signed statement that TOTALgli� PERMIT TO
A m m he is licensed pursuant to the provisions of the Contractor's License -
F'zi Law(Chapter9(commeTongwithSection7000)ofDivision3ofthe f`�LdG
¢ -' Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEEL -
¢ f D the basis for the alleged exanptiun.Any violation of Section 7031.5 `� STORIES -.TYPE CONETR.
by any applicant for d permit subjects the applicant o a civil penalty ALTER-DRAIN&VENT-WATER IEA
of ngt-Innm(Iran live branched dollar,($500).): p
I,us,nwner of,the property,or my employees with wages as- BACK FLOW PROTECT.DEVICE 4.00 C.GROUP RES.UNITS
' t m le compensation,will do the work,and the structure Is not
intended or offered for-sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND.
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTURES-PER TRAP 5,00 SO,FT,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-11NC.40UTLETS.4)-.00
or improvement is sold within one year of completion, the owner- GAS-'EA:SYSTEM-OVER 4 (EA.) 2.00 - BUILDING USE
builder will Imvc tire f p
e burden oroving that hedid not build or int- - RES IND CON PB Omar
prove for purpose of sale.). I INDUSTRIAL WASTE INTER. 30.00
C I,as owner of the property,am exelusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contraclon.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
1 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 Contmeloos)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. - PARCEL NO.
v : ❑ 1 am exempt under Sec. ,BAP.C,for this
WATER HEATER W/VENT 6.00
. ` 2a9a � .
Owner Dol WATER SYSTEM 5.00 '
ACC.DATE ACC.FILE NO.
WORI:ERs conlPliNsn NDIicIARATI N WATER TREATING'EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,' - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lm CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRESPRINK ENERGVd34
Z- ❑ Certified copy is fled with the city inspection Division. MISC. REFER TO ORD.
O Applicant . V ❑ N❑ Y ❑ N[3
~ w - PERMIT ISSUANCE —19.00 _
a' cc CIi RTIFICATE OF EXEMPTION FROM WORKERS' FLOOD zorvE A.L.u.c.
'
W > COMPFNSA'f10N INSURANCE PLG.CONTR. LIC.NO: PLO.
M O (This section need not be completed if the permit is for one - _ TOTAL Y F-1N❑ Y El N❑
Z Z hundred dollars IS 100)or len.) I -
U O- 1 certify that in the perhormmnce of the work lilr which this per CITY. - MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,1 shall not employ any person in any Rome,so as m
become subject to the W'orkeri Compensation Laws of California.
LU
Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ w NOTICE TO APPLICANT: If,after making this Certificate of Bx-
? emption,you should become subject to the Worker.'Compensation APPLIANCE 5.00 - PLAN CHECK
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=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY . AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE
I hereby affirm that there is a corutruclion,lending agency for EXHAUST HOOD(WITH DUCT) 5.00
(he performance of the work for which this permit is issued(Sec. MICROFILM
3097,Ci V C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00'
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.M.50 - ELECTRIC
1 L ,lily that I have rad this application and:tate that the above VENTILATION FAN (SINGLE), 4.00
huornation is ore cl I agree to comply with A Cry and county .. PLUMBING
ordinances and state lows retailing to building construction, and BOILER:COMP(3 H.P.or 100,000 B.T.U.)-6.00
lir by autlloriL r pres nlativ s of this city to ,ter'upon the BOILER-COMP (Own 100,000 BTU)SEE FEE SCH. MECHANICAL
above mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO'ORD.
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
ranting of this permit MECH.CONT. LIC.NO. MECH,
1 TOTAL TOTAL
gnature of Applicant/Cony ale -
OFFICE COPY