13891 (2) POST.THIS C NEAR FRONT OF BUILDING '
PFR MIT NUMBER
.CITIF CUPERTINO
INSPECTION DIVISION, '.
-JOB INSPECTION RECORD, -
r
I
PERMIT EXPIRATION
JOB ADDRESS 21591 REGNART ROAD ' ".uNlr# LOT#�-
- PERMIT EXPIRES IF WORK.-
OWNER" CABBIE 'RUTH ,CUI;P. CONTRACTOR '+' :F IS NOT STARTED WITHIN
INSPECTION DATE I INSP CTOR INSPECTION RECORD 780 DAYS OF PERMIT ISSU-,
FOUNDATION' Q1 ANCE OR.180 DAYS. ROM
UFER - " LASTCALLED INSPECT,1ION.
PREGUNITE. - * PERMIT VALIDATION
Or
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB' , '
PLUMBING .. -
ELECTRICAL., - :21 IhSSUANCE,DATE
MECHANICAL'
❑LUG. ELECT;'+L•PLG MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED T BUILDING PERMIT
.WOOD FLOOR - INFORMATION
PLUMBING - _ �AwnnON SiF1.,
MECHANICAL L - - - - - -
ELECTRICAL° PERMIT TO I,
d
FRAMING
INSULATION STORIES TYPE.CONSTR.
.- .. UCC.AHOUP RE:S.UNITS
D ,
•PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF Sa FT.FLOORAIIPA ,TOTALACHFAGE
DIAPHRAGM
BUIl:D USf'."
- .. .. Hes' IND CON Pe oleo•:
APPLYNO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSOIIS PARCEL NO.
ROUGH
J PLUMBING 4 GAS TEST -
TRACINO. `PARCEL NO.
� � � � -
MECHANICAL
' "ELECTRICAL FINALS DATE INSP, ACC.DATE,� ACC,FILE NO.
FRAMING d - SAN #, -
INSULATION PLUMBING
ZONING ENG.SITE NO.
� ,
GAS
FIRE SPRINK ENERGY T24
. S MECHANICAL v ❑ N❑ . Y Q N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING'
FLOOD ZONE A.L.UV
LATH'=INTERIOR. - ELECTRICAL
LATH=EXTERIOR' P r FIRE DEPT. ' v❑ •.N❑ y ❑ � N❑
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR)' BUILDING —Zb _
SHEAR EXTERIOR - - TEMPORARY APPROVALS BUILDING..
FIREWALLS ', wy ` y. ' ELECTRIC PLAN CHECK
GAS FEE f '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 41
. OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252 4505, ELECTRIC
I"'� ' ONE WORKING DAY BEFORE'REQUIRED INSPECTION., 7PLUMBING f
OPLEASE,GIVE JOB'ADDRESS WHEN.PHONING.
•' Z - - -" MECHANICAL .
-'SEE PERMIT FOR EXPIRATION DATE —
J' CONST'.TAX +
• IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR,FINAL INSPECTION. r 'TOTAL �(
1, -OFFICE COPY _ .
APPLICANT TO FILL IN INFOR�TION WITHIN RED LINES - USE WOPOINT PEN ONLY
BUILDING PROJECT I DENTIFICATIO PERMIT NUMBER '
nD Lo,NG APPLICATION & PERMIT
ADDRESSBUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13891
I OWNER' -INP
CHECK VALIDATION
"A / OTY: ELECTRIC PERMIT FEE
ONE 7
NAMCONE acTDRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC,NO, LIGHTING FIXTURES 40.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS - -10.00 . DATE OF APPLICATION
ARCHITECT , PLAN GHECK�FEE P,C.N0.
on PANELS (OVER 200 AMP) 20.00 '"'
ENGINEER
- LIC NO. SIGNS TRANS. 3.00 -
ARCH.ORENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00 1 •_
ZIP ITEMP.METER OR POLE INS. 20.00 j
APPLICANTS -
ADDRESS MOTORS - SEE FEE SCH. f ( �`Cve?r�SERVICE CHANGE '20.00 '
C o LICENSED CONTRACTORS DECLARATION
a v I hereby affirm that I..,•licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MECH.
0�i License Professions Code,and my license is in full tutee and effect. ❑ ❑ ❑ ❑
G i w o License Class Lin Number
Date Contractor
Q y f -
F o w a OWNER-BUILDER DIiCLARA'fION BUILDING PERMIT
°A ° s MISC.- REFER TO ORD - INFORMATION
F
a- u r- 1 hereby affirm that 1 am exempt trent the Contractor's License
u O ¢ Law for the followin reason.(Sec.7031.5,Business and Professions `/A�LU TION. $/FT.,
-ry g .PERMIT ISSUANCE 10.00 1
F w>
Code:proe,Any'nty nr,cowdy which Structure,
requires une, prior t o construct,after,
m to a p improve,demolish,or repair any structure,prior to its issuance;also ELEC.CONTR. LIC.NO. ELEC.
As LL requires the applicant for such permit to file a signed Sta rmat th.t TOTAL
w he is licensed pursuant to the provisions of the Contractor's License J��.PERMIT TO .
H z i Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe � L�
I j0 Business and Professions Code)or Him he is exempt therefrom and CITY. PLUMBING PERMIT =FEE
I- .the basis for the alleged exemption.Any violation of Section 7031.5
y i S- by any applicant for a permit subjects the applicant ilia civil penalty STORIES TYPE CONSTR,
of not more than five hundred dolars(S500)). ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 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. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 -
Code:'file Contractor s'License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-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 sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the own _
' builder will have the burden of proving that he did•not build or ier-nt. GAS'-,EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose ofsule.). INDUSTRIAL WASTE INTER. 30.00 RES ' IND CON .PB Other
❑ 1,as owner of the property,.all exclusively contracting with
licensed contractors to construct the project(Sec, 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'fhe 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 for such projects with a cmilnmtor(s)licensed�ursuaV to
the Cmltact.,%License law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT . 6.00
nicer
Owner Doc WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0.- -
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cenifiewc of consent lo'self-insure. -
_, or a certificate of Workers'Compensation Insurance,or certified ZONING ENG.SITE NO.
copy thercof(Sce.3800,Lab.C.). '
Policy No. Company
O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is filed with the city inspection division.
� O APplicant MISC.- 'REFER TO ORD. ' Y� NE ' YQ N�
CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. �. PLG.
CL 0 (This section need not be completed if Om permit is ]or one TOTAL ' Y❑ N❑ Y 'N
� Z hundred dollars IS 100)or less)
L) O 1 certify that in the performance of T FEE FEE SUMMARY
the work for which this per- CITY. MECHANICAL PERMIT
LL F mit is issued,I shall not employ any person in any Goner so as to
O W become subject to the Workers'Compensation Laws of California. F�
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING L{-O
>_ to NOTICE'f0 APPLICANT' If,after making this 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 L
U' such provisions or ibis permit shall be(learned revoked. - AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 FEE 3
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000OF.M.) 6.00 ,SEISMIC FEE s-0
I hereby affirm that the, is a construction lending agency 1'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Address HEATI NG UNIT(OV ER 100,000 B.T.U.19.50 ELECTRIC
I certify that 1 have read This application and stale that the above VENTILATION FAN (SINGLE) 4.00
inforroohn is correct.1 agree to comply wilh all city and county PLUMBING
ordinances and slate 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 tile BOILER-COMP IOvar 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.
Cupertino against liabilities,judgments, costs and expenses which :CONST.TAX -
moy'in any way accrue,against said City In conseljucnce of the PERMIT ISSUANCE t 10.00
gmOt10 o(Ihls pcnn2 q. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 3a� .
I of Applicant/Contractor Date �•
OFFICE COPY