12955 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO ' ERMIT NUMBER
INSPECTION DIVISION 12955
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 1`9447 PRUNERIDGE uN1T# _ LOT# PERMIT EXPIRES IF WORK
OWNER HEWLETT PACKARD CONTRACTOR REDWOOD MECHANICAL IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPEQCTION RECORD
OD,_,_r�A 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS R
OM
LIFER f ✓,8� a hA PF^�I LASTCALLED INSP CTIOPr'
d2 y_ ALA
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / >
UNDERGROUND /SLAB
PLUMBING - 1
ELECTRICAL lv ISSUANCE DATE
MECHANICAL B❑ ey0r`t)yP �91 M,��
yt
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUU.PING PERMIT
I I •CI FORMATION
'WOOD FLOOR VALUATION s/FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIrr
FRAMING -
INSULATION - SrORI / TYPE CONSTR.
OCC.GROUP RES.UNITS
I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
/ RES IND CON PB 09',
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E:l 0 0 0 D
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T 24
MECHANICAL YF] NE] YC] N[:]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH—INTERIOR ELECTRICAL FL000 zO A.L.u.C.
LATH—EXTERIOR FIRE DEPT. Y "C3 Y ❑ NF]
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR - - BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS • eulLDuvG -
FIREWALLS - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE NAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSfGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
�7 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
` 1 1 LINE APPLICANTTO FILL IN INFORMATION WITHIN RED 7o5 9//,5- USE BALP INT PEN ONLY
BUI DING PROJECT IDENTIFICATION „Q„ I PERMIT NUMBER
oDILomG' ,/JUru /ya} APPLICATION & PERMIT#
ADDRESS 100 r
19(1-117
(1y r BUILDING- ELECTRICAL-PLUMBING-MECHANICAL 12955
O R's PLAN CHECK VALIDATION
XK�IiL� OTY. ELECTRIC PERMIT FEE
rvraa roll's -- nn OUTLETS-SWITCHES-RECEP 10.00/1.00
1 C3X LIC.NoI ' LIGHTING FIXTURES 10.00/1.00
1:5APPLIANCES-RESIDENTIAL 4.00
s
3 P PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLANCHECK FEE P.C.NO.
OR .
ENGINEER
LIC.NO. SIGNS TRANS. 3.00 f.
ARC".ORENG. SPECIAL CIRCUIT 5.00
P RMI AlIDATIONADDRESS
ZIP TEMP.,METER OR POLE INS. 20.00 -•
APPLICANT'SI -
9�REss •�• X I p MOTORS SEE FEE SCH.
K(„L,x CH -- I�p SERVICE CHANGE 20.00 �Afy pt lU, yl
l
w o O LICENSED CONTRACTORS DECLARATION
a,ZU U 1 hereby affirm that I am licensed muter provisions of Chapter 9 ISSUANCE DATE �Q
"' (commencing with Section 7000)of Division 3 Of the Business and BLDG. ELECT. PLG, MJ_
i )r{oSevs' ns, Ip C a n li-ns}.y'in full far :anr e f �
2 o w C[lt fi-46-'ItCf 17 Y11q'Numbcy�ttj^1l.'�jyp QC
O H O Datc e-l" I Conlrudor_I
H - s PATIS_ :YLTY'1f BUILDING PERMIT
a m aa a OWNER-BUILDER DIiCLA Al'
e m U INFORMATION
I
3 LL I hereby collo that I so exempt from the Contractor's License MISC.- REFER TO ORD
H u O Law far the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
,A0 Code:Any cityorcounty which requires a permit to construct,alter,
CQ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
iLLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w$ he is licensed pursuant to the provisions of Die Contractor's License
rii Law(Chapter 9(commencingwith Section 70000.1'Division3ofllle
- a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
rc = the basis for the alleged exemption.Any violation of Section 7031.5 STO VP ONSTR,
a ; •- by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 Jam'
of not more than five hundred dollars($5000.)
s
❑ 1,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 to (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5,00NJ--
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 atimprove- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
improve-
'ems are not intended or offered for sale.It',however,the building
Or improvement is sold within one year of completion,the owner, GAS-EASYSTEM-OVER 4(EA1 200 BUILDING USE
builder wI him . . .
ill have the burden of proving IIo e did not build or - RES IND CON Pe Omer
nt
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 El❑ 1,as owner of the property,am exclusively coracting with
licensed contractors in constructthe 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 riot apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contrathe Cont for such License
Lwithumntractor(s)licensed pursuant to SEWER-SAN ITARY-STOR M EA.200ft110.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
WORKF-RS'COMPL'NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sel Ginsure, ZONING
or a certificate of Workers'Compensation Insurance,or a cerlifieJ ENG.SITE NO.
4t r1�80Q„{.pb.C.)tp
n• l nc•-n__Accid ch
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T 24
Z Z q�� Cerrl��yyeiAan�py��1��,[[��Irgqq wsy�g�I�l�e�y1 spp��cti 1 ion.
O AfrplicaRlf�.LllLX1C11_71 �Ll.1_llrd MISC.- REFER TO ORD. v � N[3 y ] NPT PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
r CERTIFICATE E IiAI ION'INS PROM WORKERS'
W >_ COMPGNSATION INSURANCE .0 NTH. Gf3H01A ' PLG. '-'1/�/�/N ❑ ❑ ❑ ❑
CL 0 (This section need not be completed if the permit is for one ��JJ..JJ��--�I�r.�,JJ TOTAY7C�l�lJ Y N v N
Z) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued.I shall not employ any person in any mmnner so as to
U become subject to the Workers'Compensation Laws of California.
0 u Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: IL after making Ibis Certificate Of ISA
F 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 swell provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10PIXIC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performanceof the work for which this permit is issued(See. MICROFILM
3097,Civ.C.). l r.I�✓Y,u�� 3 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)8.50
Lender's Address ELECTRIC
I certify that 1 have read this applicetiml and stale that the above VENTILATION FAN (SINGLE) 4.00
information is Correct. 1 agree to comply with all city anti county PLUMBING a Od
'�. ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)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
in any way accrue against said City in consequJ/9�c of the
ran ing of this permit. 7 CH. O T. LIC.NO. MECH.
p CQQ ��I TOTA, TOTAL 5900
nature of Applican t/Contractor Dmc �`-�
OFFICE COPY