13446 (3) POST THIS CARD NEAR FRONT OF BUILDING
PFP41IT NUMBER
CITY OF CUPERTINO
'INSPECTION DIVISION 13446
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10280 Pharlap Ave UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER L. Leonardis CONTRACTOR _ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD >/ 180 DAYS OF PERMIT ISSU-
FOUNDATION ANC. OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITETc` ky,;`� PERMIT VALID A TION
f
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING C� F� o4�u4e �n9
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG, ELECT. PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WINFORMATION
WOOD FLOOR
PLUMBING / �p LUATio^ s/FT.
MECHANICAL - C([J)/
ELECTRICAL T�
FRAMING -(2.
STORIES TYPE CONSTR.
INSULATION
OCC.CROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT.FLOOR AREA TOTAL ACREAGE
I. . DtAv4�a qw." I __lL BUILDING USE
1� Or `,. +M
�P
RES IND CON PB oma,
APPLY NO ROOF NG UNTIL ABOVE HAS BEEN SIGNED ❑ '1:1 El ❑ ❑
ASSESSORS PARCEL NO.
ROUGH _-EXPIRED
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC,DATE ACC.FILE NO.
FRAMING - SAN #
INSULATION - - PLUMBING zoNlNc ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ " Y NE]
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C,
LATH-EXTERIOR FIRE DEPT. Y❑ No Y ❑ N❑
SHEETROCKGRADE - FEE SUMMARY
SHEAR INTERIOR ^ - - BUILDING
SHEAR EXTERIOR -1 - TEMPORARY APPROVALS BUILDING � . ,••�
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTff`UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. :MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Fw- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT[ CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL /
CALLING FOR FINAL INSPECTION. 7�
OFFICE COPY ,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION PERMIT NUMBER
,� BUILDING APPLICATION U PERMIT 13446
�� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER' f� /�] PLAN CHECK VALIDATION
"nme �TC� OTY. ELECTRIC PERMIT FEE
r S vNONE - �a
/ NAMERAc*oas UTLETS-SWITCHES-RECEP 10.00/1.00 s�
LIC.No, LIGHTING FIXTURES 10.00/1.00 TQ
CONTRACTORS
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
C
PHONE PANELS 10,00 DATE OF APPLICATION
ARCHITECT . FwI'IL`/jam ' PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE P.C.NO.
uc.uo1e
/n SIGNS TRANS. 3.00
ARCH Ian2nls SPECIAL CIRCUIT PERM TLVAW DATION
AooRes 5.00
L�•��l zIP r EMP.METER OR POLE INS. 20.00 I f3
APPLICANT'S MOTORS SEE FEE SCH. " s'•"
ADDRESS 2
SERVICE CHANGE 20.00
C)q! of Cupertino
o0 LICENSED CONT RACTORS DECLARATION
Q u U I hereby affirm that I an,licensed under provisions ol'Chapter 9 ISSUANCE DATE
y (commencing with Section 7000)of Division 3 of the Businessand BLDG. ELECT. PLG. MECH.
I_w i Professions Code,and my license is in full force and effect. ❑ ❑ ❑
o 0w W License Class Lic.Number
N
Date Contractor
' F J
w ¢ OWNER-BUILDER DECLARATION 'DING PERMIT
o a U REFER TO ORD INFORMATION
X ; u r I hereby affirm that I am exempt from the Contractor's License MISC.-
w u O Law for the fallowing reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
ry J Code:Anycityorcounty Which requires a permit to construct,alter,
2 a¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
O u requires the applicant for such permit to file a signed statement that TOTAL 'PERMIT TO
w$w he is licensed pursuant to the provisions of the Contractor's License
Fz > Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant far.permit subjects the applicant toa civil penally ALTER-DRAIN (EA.) 5.00
c f not more than five hundred dollars(5500),):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4,00 Dcc.CROUP RES,UNITS
Their sole compensation,will do the work,and the structure is not
intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
_ 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 IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided That such improve
ments are not intended or offered for Male.If,however,the building GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4(EA) 200
" builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB ' Omar
CILas 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 property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsuch projects with a contractors)licensed pursuant to SEWER-SAN V-STORM EA.200ft/70.00
the COntractorS License Law. TRACT NO. PARCEL NO.
❑ lame mpt oder Sec. ,B.&P.C.fo,this WATER HEATER W/VENT 6.00
reason
�� Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
K W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLC.
CL O (This section need not be completed if the permil is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars(SI00)or less.)
U O 1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
0 WIL. Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING WJ-U
} N NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
?
caption,you should become subject to the Workers'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=CF.M.) 4.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 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. MICROFILM
3097,Civ.C,). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction;and BOILER-CON?Q H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of This city to enter upon the BOILER-COMP (Over 100,0008TU)SEE FEESCH. MECHANICAL
above-mentioned property 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 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 TOTAL 7
Signature o(Applicanl/Contractor Date •/
OFFICE COPY