15392 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER
CITY OF CUPERTINO 15392
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10199 Prado Vista Avenue UNIT# LOT#
" - � - PERMIT EXPIRES IF WORK
OWNER Wynholds I I CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .'IBD DAYS RF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
LIFER, ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
- CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED3-22- f o excep �K cp,, �g t,
UNDERGROUND /SLAB. `� q
PLUMBING
ELECTRICAL " U e.ISSUANCE DATE
MECHANICAL �• 1�e�CCDc:� •ec cr PLG.- MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION p, $/FT. .
PLUMBING
MECHANICAL '
ON
ELECTRICAL PERMIT TO
FRAMING _ -
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sO.rr rLDO.AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOFSHEATHING ,HES 'IND Luiw NusEPR
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El 0 ❑ ❑ Q
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING _1/- ELECT.ENERGY
iHnCl NO PARCEL NO
TUBSB SHOWER PAN PLUMBING ENERGY '
MECHANICAL, MECH.ENERGY
„ ELECTRICAL - BUILDING ENERGY ACG.DATE Acc.EILe rvo
mw
FRAMING —ZZ-BSC ELECT.FINAL TEST zoNlNc ENG.SITE No.
INSULATION tib '�-z - PLUMBING
GAS TEST _ GAS
MECHANICAL FiHESPH INK ENERcv T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING L U
' EXTERIOR SHEAR - - - ELECTRICAL RELEASE
S+ O00 ZONE
INTERIOR SHEAR. FIRE DEPT, v� "� A L YL N❑
SHEETROCK _7 N C, GRADE FEE SUMMARY
EXTERIOR LATH W- 4'88 ; BUILDING
INTERIOR LATH - TEMPORARY APPROVALS BUILDING
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 FINAL IS SIGNED BY BUILDING INSPECTOR. -MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I I-- ONE WORKING DAY BEFORE REQUIRED INSPECTION.
t °z PLEASE GIVE 308 ADDRESS WHEN PHONING. PLUMBING `
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL j
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 .
•
BUILDING PROJECT IDENTIFICATION -PERMIT NUMBER
BUILDING I .J
APPLICATION & PERMIT 1 [
ADDRESS
T BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
392
OWNER E PLAN CHECK VALIDATION
_ NAM-/1 5- QTY. ELECTRIC PERMIT FEE
V� PMDNEA _J/Oo
NAMERac OR's UTLETS-SWITCHES-RECEP 10.00/1.00
UlSec.rvo.S17 7I1 15 LIGHTING FIXTURES 10.0011.00 Q
--r. ADDRESSTo s APPLIANCES-RESIDENTIAL 4.00
PANELS 10,00 -^t DATE OF APPLICATION
W-,IP
PLAN CHECK FEE R.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER _I
Sec.NO, SIGNS TRANS. 3.00 1`� r 5.1�
ADDRESS ENG. SPECIAL CIRCUIT 5.00 Til PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 ,�ne1t1�
APPLI IF'C
ADDREss MOTORS SEE FEE SCH. �ly� � _
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION J
Es U I hereby affirm that I am licensed under provisions of Chapter 9 ,. ISSUANCE DATE
v, w I commencing with Section 7000)of Division 3 of the Business and --
4 H )BLDCJs:ELECT. PLG. MECH.
0 N- LiceneProfession,CoC.4 and my Ilcense is In full force and effect, y l
z O m- License C ass ALL_1-ic.Number. ((7 If�Vfl
m r w Uulc�' �_\--I-aV_Conlructor-
4 m P1M1V 0 U11E"BUILDING PERMIT
a
at 4 OWNER-BUILUER UL'CLARANON -
a a 0 INFORMATION
wg; N I hereby affirm That I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION r IL ID 4 Law for the following reason.ISec.7031,5,Businessand Professions PERMIT ISSUANCE 10.00 d 5/FT.
Code:Any city or county which requires a permit to construct,alter,
QQ <0 II11prr1Ve,demolish,Or repair ilOy Sllnetnre,prior to its issuance.aI50 ELEG CONTR. LIC.NO. ELEC.
D ¢ requires the applicant forsuch permit to file a signed statement that TOTAL PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License /
FZQ Law(Chaptar9(commencingwlDl SCction7000)Of Division3ofthe L'„rl�(AG�GTC�
4 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
aSbyany applicant for a permil Subjects Ole applicant to a civil penally ALTER-DRAIN -WATEfl IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees 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 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 docs such worF IXTUR ES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
•� himself or through his own employees.Provided"I'm such impk ruse- _
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
budder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Osber
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 11 ❑ 11 ❑ IDlicensed 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 projectswith a contractors)licensed pursuant to SEWER-SAN V-STORM EA.2001t/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.lor this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKBRS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby atfirm that I have a certificate ofconsenl Io selfhoure,
or a certificate of Workers'Compensali1on Insurance,/or a cerlified ZONING ENG.SITE NO.
-y.
Policy
there copy thepL'ISep
c
O ❑ Cetlificdc yis here rnished. FIRE SPRINK ENERGY T24
Z
2 ❑ Cerii py i 1 ed w h the city inspection division.
O Applicant_ MISC.- REFER TO ORD, y ❑ N❑ v ❑ N❑
~ to PERMIT ISSUANCE 10.00 61
� - CERTIFICATE OF IiXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. G
CL Z ffhis Section need not be completed if the permit is for one TOTAL Y[:] N❑ Y F] N❑
hundred doIImS(SI00)orlCss.)
U 0 'b certify that in the performance of the work for which this Per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1 mit is issued,I shall not employ any person in any tanner so as to
O Wbecome subject to Ole Workers Compeoution Laws of California.
C. Date Applicant ALTER OR ADD TO MECH.
>_ m NOTICE TO APPLICANT: IL after making this Certifi.te.I'Ex-
p
5,00 BUILDING 30
F ? emption,you should become subject to the Workers Compensalion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be decried revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I 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 iesuad(See. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT 100,000 B.T.U.)9,50
Lender's Address ELECTRIC'
I certify that 1 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 '36 �-
�= ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
thereby authorize
ned property tarvespof this
purposes.
(Wc) agre to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino ag mit liabilities,juJgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay i y ay Tcerue against Said City in consequen of the .0
coli 1 i rm MECH.CONT. LID.NO. MECH.
TOTAL TOTAL
• ignat Ire plicanl/Contra ate
OFFICE COPY