14095 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO RMITN MnAEq�j
. INSPECTION'DIVISION 14095
JOB INSPECTION RECORD
+ PERMIT EXPIRATION
// JOB ADDRESS 22540 ROCARDO ROAD UNIT 4*--LOT:ff PERMIT'EXPIRES IF WORK
OWNER HILL, LYNDEL CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED INSPECTION.
LIFER
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE'UNTIL ABOVE HAS BEEN,SIGNEDI,
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL RLOG. ELECT: PLG. MECH.
❑ 1 ol ❑ ❑'
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ,.BUILDING PERMIT
INFORMATION
WOOD FLOOR vALuanoN S/FT.
PLUMBING
MECHANICAL `
PERMIT TO
ELECTRICAL /
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
\ SO.FT.FLOOR AREA TOTAL ACREAGE
t• DIAPHRAGM ROOF
/ BUILDING USE
- - RIs IND CON PR Otl,w
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
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 • v ❑ N[:] v ❑ N[]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING D- O
LATH—INTERIOR ELECTRIC FLOOD ZONE Ac.
LATH—EXTERIOR FIRE DEPT. v� N� Y 0 I] N❑
SHEETROCK GRADE ,FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
L =SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! coNsr.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
BU LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT
AOD
!' _/c i�sl-P Do BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 140 5
Ova ry 'S•-7 L PLAN CHECK VALIDATION
NA E /
= ELL L
QTY. ELECTRIC PERMIT FEE
J rRacr 's 2�
OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
uc.NO LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
Lu.No. SIGNS TRANS. 3.00
ARCH.OR END SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP` TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS �.
SERVICE CHANGE 20.00
Doo LICENSED CONTRACTORS DECLARATION /eIY3`/,�"
Q Z w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing withSection7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Ni Professions Code,and my license is in full force and effect ❑ ❑ I� r%11
z o y- License Class Lic.Number I•r"7 r%11
2 z v. w Dam Contractor
a x f d BUILDING PERMIT
¢ ¢Ic LL ¢ OWNER-BUILDER DECLARATION -
X
;LL'I- I hereby affirm that I Bm exempt from lhC Contrumor s License
MISC.- REFER TO ORD INFORMATION
u o a Law for the following reason.(Sec.7031.5,Business and Professions PERMfT ISSUANCE 10.00 VALUATION $/FT.
Hy Code:Any cityor county which requires a permit to construct,alter,
¢ U,Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
-DLL requires the applicant for such permit to File a signed statement that TOTAL - PERMIT TO
u w Dm he is licensed pursuant to the provisions of the Contractor's License �(�� 9
H z: i Law(Chapter 9(commencing with Section 7000)n f Division 3 ofthe / I J�pL.
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M F m the basis for Ilse alleged exemption.Any violation of ScrfUm 7031.5 STORIES TYPE CONSTR.
ii _ by any applicant for a pundit subjects the applicant boa civil penalty
of not more than five hundred dollar.,(S5000.).. ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the properly,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(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Code:The Contractor's License Law does not apply to an owner of
\1 property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTALACREAGE
~•/ himself or through his own employees,provided that such improve.
J me nus are not intended or a ffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int- - . BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
❑ I,as owner of the property,an exclusively contracting with '❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I 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
eormacts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00
the Contractor's Licensc Law. TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ' ,B.&P.C.for this WATER HEATER W/VENT e,-. 6.00
reason
Owner rLt Date ��{J7- WATER SYSTEM 1,-In> 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATIOD - WATER TREATING EQUIP. _ 5.00
1 hereby affirm that I have a certificate of euioant to self unsure, Cl -. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,ora certified
copy thereof(Sec.3800,Lab.C.). ^ it 0
Policy No. Company )
aHA
O ❑ Certified copy is hereby furnished. C1 I] 01 VOrV FIRESPRINK ENERGY T 24
Z 2 ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
Hy PERMIT ISSUANCE 10.00 U FLOOD ZONE A.L.uc.
LU CER'I'I PICCOI OE EXEMPTION FROM WORKERS'
CL COM Lot he IONcoo INSURANCE PLG.CONTR. LIC.NO. PLG. 2 r� Y❑ N❑ Y❑ N❑
CL Z 1'1'his section need not he completed if the permit is for one TOTAL L^G J
hundred dollars IS 100)or less.)
V O I certify that in the performance of the work for which this per, QTY MECHANICAL PERMIT FEE FEE SUMMARY
ly mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
y Dam Applicant ALTER OR ADD TO MECH: 5.00 BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex
F 2 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)00DQF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DU�TIIv
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 E LECTR I C
I certify 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 r
ordinances and state laws relating to building construction, and BOILER-OOMP(3H.P.Or100,000B.T.U.) 6.00
hereby authorize representatives of this city to Cater upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (�
bove-mentioned property for inspection purposes. p
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
etlino against liabilities,judgments, costs and expenses which CONST.TAX
in any a C u• ' s id City in cnnseyuence of the PERMIT ISSUANCE 10.00 �O
go ing of tl'S MECH.CONT. LIC.NO. TOTAL /Q ✓ TOTAL / J 0-00
Sign a of Applicant/Cont actor Date
OFFICE COPY