15457 (2) POST THIS CAR D.N EAR FRONT OF BUILDING PERMITNUMBER
CITY OF CUPERTINO 15457
INSPECTION DIVISION,
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10571 North Portal UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER ' Stuart D.•- Chessen CONTRACTOR. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1B0 DAYS OF PERMIT ISSU-
FOUNDATION - - AN CE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
.TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE .CUPERTINO STANDARDS. - 1
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .y
UNDERGROUND /SLAB • '^•
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT I PLG. MECH
❑ ❑ 21 ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL aT7
ELECTRICAL PERMIT TO
FRAMING I,
INSULATION STORIES - TYPE CONSTR
It.
OCC,CHCUP Rf:S UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.Fr FLOOR AREA TOTAL ncBPAee
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES IND CON PB ons.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
�
ROUGH SAN.H
ASSE SORSPAR CELNO
PLUMBING ELECT.ENERGY
TRACT NO - PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY -
FRAMING ELECT.FINAL TEST
ZONING' ENG.SITE NO.
INSULATION - PLUMBING �y-.
+ GAS TEST - GAS
MECHANICAL FIRE SPR INK ENE RGv r as
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` "� "�''
4
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE LUC.
INTERIOR SHEAR FIRE DEPT. v❑ NE] Y ❑ No
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH I BUILDING BUILDING
INTERIOR LATH Tf MPORARY APPROVALS
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
Q4
ARRANGE FOR INSPECTION BY PHONING 252-4505, x'". ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
• o� PLEASE GIVE JOB ADDRESSWNEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
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
- BUI LDI NG PROJECT 1 DENT[FICATI ON PERMIT NUMBER
BUILOING
ADDRESS
DAPPLICATION & PERMIT 154 57
/0 71 •IV, )POk r-- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �R .
OWNER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
_T" D C�^��HONI /�V 408
NAME AcrORs UTLETS-SWITCHES-RECEP 10.00/1.00
LICHO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS'
ADDRESS
APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
oncHITEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.O.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 100
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
Woo LICENSED CON TRACTORS DECLARATION 0/3/a
a o I hereby off nn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y w (commencin with Section 7000)of Division 3 of the Business and
a g BLDG. ELECT. PLG. -MECH.
H O i Professions Code,and my license is in full force and effect. El ❑ El
O License Class Lic.Number
Q m H a' Date Contractor
¢ x f BUILDING PERMIT
¢ ¢ w ef OWNER-BUILDER DECLARATION - INFORMATION
o d MISC.- REFER TO ORD
K
?� LL w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
a, o ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
FN0J Code:Any city or county which requires a permit tocons'truct,alter,
an improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n wm¢ requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License - ry n
H z r Law(Chapter 9(commencingwilh Section 70000of Division 3 ofthe LQ 6-
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M H G the basis for the alleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
i 3 by any applicant for a pemhit subjects the applicant to a civil penalty
of not more than five hundred dollars($5000.) ALTER-DRAIN& VENT-WATER (EA.) 5.00
O 1,as owner of[lie property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,will du the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:rhe Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does Such work FIXTURES-PER TRAP 5,00 50.IT.FLODR AREA TOTAL ACREAGE
• hfmwlf or through hisown employees.provided that such improve-
ments are not intended or offered formle.If,however,the bud4
ding GAS-EA.SYSTEM-1 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 he did not build or im- . . .
.`a BUILDING USE
prove lnee of sale.). ' .❑ E) El ❑ .1:1I,as us o RES IND CON PB Other
o
O 1, owner of the properly,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 s { ASSESSORS PARCEL NO.
and Professions Cade: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.)Il1{1.00 V
contracts Comporh projects Lmwtl SEWER-SANITARY-STORM EA.200ft/10.00
with cnntruorfsl.lfcenpursuant to
the Contractor r%s Law. T,• 1"`TRACT NO. PARCEL NO.
❑ I am exempt under See. ,B.&P.C.for this WATER HEATER W/VENT 6.00
re'Ja011 '
Own Dmc f WATER SYSTEM 5.00 ACC,DATE ACC,FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm [bat I have a certificate of consent to self-insure, ZONING - ENG.SITE N0.
or a certificate of Workers:Compensation Insuranse
ce, r a certified
copy thereof(Sec.3600,Lab.C.).
Policy No. " Company
O ❑ Certified Copy is hereby fumished. FIRE SPRINK ENERGY T-24
Z ❑ Certified copy is filed with the city inspection Division,
0 Applicant MISC:- REFER TO ORD.
Y ❑ N❑ v ❑ N❑
CCL4PERMIT ISSUANCE 10,00
LU 1 CIiRTIFICCOMPh NSAT10N INSURAATEOF EXEMPTIONONCE ORKIiRS' PLG.CONTR. LIC.NO. PLG. ) FLOOD ZONE AL.U.C.
CL 0This section need not be completed if the pern.it is far one TOTAL6 y❑ N❑ v❑• N
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL H nrit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensalion Laws of Calfforniu.
�.6` Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making[his Certificate of Ex-
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
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=1C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of,tlle work for which this permit is issued(Sec. MICROFILM
3097,Cfv,CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's theme HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certil'y.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-COMP(3 H.P.Gr.100,000 B.T.U.) 6.00 lcP ✓
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. 801 LER-COMP IDVBr 100.000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep ha nn less the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs send expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may i any way Scene against mid City in conseq enc of the
ran Ibis penal MECH.CONT. LIC.NO. MECH.
n 3 �Fi TOTAL TOTAL
Signafureof Applicant/Contractor Date
OFFICE COPY