12385 (2) y POST THIS CARD NEAR FRONT OF BUILDING
CITY. OF CUPERTINO LfiRN9 NDA98ER
INSPECTION DIVISION 12385
JOB INSPECTION RECORD
p /y1 �'//]/ P�L'17�'�CPIRATION •
JOB ADDR ESS �// Q /�A-i n/dTU � `�� —UNIT# ,_LOT# PERND PARNPO ORK '
OWNER / (n_Q
// �/J �l CONTRACTOR IS NOT STARTED WITHIN
-f a C7,L�� 'O �.J�/
IN i N i' DA E I INSPECTOR I INSPEC ON RECORO 180 DAYS OF PERMIT ISSU-
FOUNDATION (�_L- (�Apw �p - ANCE OR 180 DAYS FROM
NI LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
slir_
POUReNONCRE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB pA10- I : FI
PLUMBING 'I(�Q7
ELECTRICAL Il9G§7INCE DATE
MECHANICAL LD ELECT. PLf. MECH.
p1 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT!
INFORMATION
WOOD FLOOR VALUATION $JET.
PLUMBING
MECHANICAL 1856000
ELECTRICAL PERMIT TO
FRAMING Single Fam:Uy O40®11
STORIES TYPE CONSTR.
INSULATION '
2 3 N. Br.
- - OCC.GROUP HES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 1
ROOF $0 FT.FLOOR AREA TOTAL ACREAGE -
DIAPHRAGM 2929
BUILDING USE
RES IND CON PB 0, e
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED a F-1 El E) El
ASSESSORS PARCEL NO.
ROUGH 77/Q Wp7riC YP,c'T oK P-31-r7,40
PLUMBING d -/?)Pour _A7_F1 0
GAS TESTTRACT NO. • PARCEL NO.
,Mq 7907
MECHANICAL .70-P,? )W, )y, ACC.DATE .ACC,FILE NO.
ELECTRICAL -,5-'J FINALS DA INSP.
FRAMING Pt,,L - SAN # d_aGjI
ZONING ENG.SITE NO.
INSU ATION .�. '� PLUMBING
�- GAS
MECHANICAL FIRE SPRINK , ENERGY ran
COVER NO WORK UNTIL ABOV HAS BEEN SIGNED HEATING Y "� "�
FLOOD ZONE A,L.U.C.
LATH-INTERIOR _ ELECTRICAL r Y Q IN Y 0 N�
LA
TH-EXTERIO FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR .3-R7 TEMPORARY APPROVALS BUILDING 645.30
FIREWALLS ELECTRIC "z9 PLAN CHECK
IT
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /I.1 +�
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILAUILDING FINAL IS SIGNED BY BUILDI NG INSPECTOR. MICROFILM
'e
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE — " MECHANICALCONST.TAX 'T' 7.3
IMPORTANT!
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
t L BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
imah- NG .. APPLICATION &PERMIT
ADDRESS 21190 Rainbow Dn. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 12385
NAMER'S (,'- - -- /// ! PLAN CHECK VALIDATION
"AME A.L. ' Y GROUP Y QTY., � � ELECTRIC PERMIT FEE
$REGORY GRODP--_�•P ONE V7 �r5<
NAME croR UTLETS-SWITCHES-RECEP 10.00/1.00 645.50
NAME
uaN ,j 00,12 LIGHTING FIXTURES 10.00/1.06 ' 160.00 paid
CONTRACTOR' Wt APPLIANCES-RESIDENTIAL 4.00
ADDRESS
C K/v PHONE V �� PANELS 10.00 DATE OF APPLICATION
OR
`q� � ��.(,(/4 / PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINE FiJ'-� L4��' 7[J, LIC,NO, . 'SIGNS TRANS. 3.00 "
ARCH OR ENG. �7 - RMIT VALIDATION
TIES s fJ /J SPECIAL CIRCUIT 5.00 `
Z P'/7�(v EMP.METER OR POLE INS. 20.00 -(
ADDRESS �a2,v MOTORS SEE FEE SCH. 1, p O
AS _ G'
C ((J(✓ y(<0 $ SERVICE CHANGE 20.00 p
r 0 O LICENSED CONTRACTORS DECLARATION - )Y Of Cupertino
¢ U U I hereby affirm that I am licensed under provisions a]Chapter 9 ISSUANCE DATE
H < a (commencing with Section 7000)of Division 3 of the Business and B ELECT. PLG. MECH.
r D i Professions Code,a y license Is in full force�p�.�fC t h IL�OG.
0 0 H o License Class Lic.Number-
2
�r'/ 94J1:1 1:1 ❑
Date Contractor 0
a Y s ' - BUILDING PERMIT
¢ a i u OWNER-BUILDER DECLARATION - ^INFORMATION
La g,� y I hereby affirm that I am exempt from the Contractor's License 'MISC.- REFER TO ORD
La u O J Law for the following reason.(Sec,7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requires permit to construct,alter,
¢ ¢iF Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. 185,000
oor
. DLL requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO
w mhe is licensed Pursuant to the provisions of the Contractor's License
r z a
Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe - - Single Family Dwa'll.
4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES -TYPE CONSTR.
a 3 - by any applicant for a permit subjects the applicant to a civil penalty gLTERDRAIN&VENT-WATER IEA.) 5.00 '
of not more thALTER,
DRAIN five bundred dollars($5000.): 2 5 N. Hr...
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 'R-3 1
Code:Tire 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 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improve-
mentsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.40UTLETS 6.00 2929
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200
builder will have the burden of proving that he did not build or im- . . .
BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE INTER3000 RES IND CON PB Other
. .
❑ 1,as 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 p
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3.x.6_
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 7907
reason
Owner Date WATER SYSTEM 5,06 ACC,DATE ACC.FILE N0.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofcousent to self-insure,
or a certificate of Workers'Compensation losur ace,ora certified ZONING ENG.SITE NO.
ropy thereof(Sec.3800,Lab.C,), ��}� 0 `
Policy Nn. Company elyl l C /`l C.
Q Certified op is hereby furnished
Z Z f� Certified Lc y is filed with the c 'nspeclln cion. FIRE SPRINK ENERGY T24
p AOlylicant y ,�iL.(I/w � MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
= w !J PERMIT ISSUANCE 10.00
LU - CERTIFICATE E EXEMPTION PROM WORKERS'; FLOOD ZONE A.L.UC.
W � COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. '
CL Z (This section need not be completed if the permit is for mm TOTAL Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)an less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 645.50
} 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? 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 10AOOC.F.M.) 4.00 p
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,1300C.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
Lender's Address - ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING'
r0r ordinances and state laws relating to building construction, and BQILER•COMP(3 H.P,or 100,0008.T.U.I 6.00
hereby authorize representatives of this city to enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ,
above-mentioned property for inspection purposes:
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. a 9�
Cupertino against liabilities,judgments, costs and expenses whioh ,PERMIT ISSUANCE 10.00 CONST.TAX t7
way accrue,again said City in consequence of the
q2gmc
is permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Applicant/C tractor Date
OFFICECOPY '