14220 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PFR\tR NUMBER
14220
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 7779 SQUIRE HILL COURT UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER M/M MILLER CONTRACTOR CABINET CONNECTIO IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
- ISSUANCE DATE
MECHANICAL FLOG. ELECT, I PLG. MECH,
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION,
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING - r
INSULATION
STORIES TYPE CONSTR,
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
. ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES INO CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ E] ❑ Cl ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO,
MECHANICAL
ELECTRICAL ACC.OATE ACC.PILE NO.
- �J MGAS
INSP.
FRAMING INSULATION ZONING ENG,SITENO,FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y ❑ N❑ Y ❑ N❑FLOODZONE A,L.U.c,
LATH-INTERIOR .
le
LATH-EXTERIORFIRE DEPT, Y E] N❑ Y [:] IN[]
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 SIGNEDoccuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
t
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 — MECHANICAL
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
� BUtLDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS n
-��C.� S 1. t BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 1422
OWNER'S J PLAN CHECK VALIDATION
. rynmEr �� E D✓ I QTY. ELECTRIC PERMIT FEE
CONTRA cTOR s OUTLETS-SWITCHES-RECEP 10.00/1.00 /0-
LIGHTING
0.00/1.00 0--
LIGHTING FIXTURES 10.00/1.00
CONTRACTORSp PPLIANCES-RESIDENTIAL 4.00
ADDRESS
lt�O 4 PRONE ' PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMPI ZO.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEEC
LIC.No. SIGNS TRANS. 3.00
ADDRESS eNc. SPECIAL CIRCUIT 5.00 O PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 n
APPLICANT s / MOTORS SEE FEE SCH. ( - �-�I `;Ayt(/-Q-/v
SERVICE CHANGE 20.00 '�` b 7
woo LICENSED CONTRACTORS DECLARATION
a v v I hereby affirm that I am licensed under provisions of Chapter 9 +:r's ISSUANCE DATE
z 1° (commencing with Section 7000)of Division 3 of the Business and
1n rt y BLDG. ELECT. PLG. MECH.
F m z Professions Co a4n y 'cense is in full I'or erre L
z o,A- License Class LIC.Numb• IRI EI
o I-' Date II-H8;11 Contracto `YY-'
a x BUILDING PERMIT
¢ ¢o EE OWNER-BUILDER DECLARATIO INFORMATION
X ; N 1 hereby affirm tial I am exempt from the Contractor's License MISC.- REFER TO ORD
F LL o a Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 Q VALUATION
m i Code:Any city or county which requiresa permit to construct,alter,
QQ Q Improve,demolish,Ur rCpalr:no,sLo,ulre,prior 10 Its Psar,ce,also ELEC.CONTR. LIC.NO. ELEC. !� (/f,
wDLL requires the applicant for such permit to file a signed statement that TOTAL J/ PERMIT TO
m he 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 �L-L G7r V-1 _
4 o Business and Professions Code)or that he is exempt therefrom and Q Y. PLUMBING PERMIT FEE r
¢F$ the basis for the alleged exemption.Any violation of Section 70313- 1 STORIES TYPE CONSTR.
a ; - by any applicant for a permit subjects the applicant 10 a civil penally
of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER IEA.) 5.00
❑ I,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,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
• property who builds or inn proves thereon,and who docs such work FIXTURES-PER TRAP 5.00 - SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
memsare not intended oroffered for sale.If,however.the building GAS-EA.SYSTEM-I INC-40UTLETS 6.00 .
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors 10 construct the project(Sec. 7044,BusinessLAWN 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 IEA.) 1.00
contracts for such projects with a contracums)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ tum exempt under Sec.-.B&P.C,for this
ason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. '5.00
1 hereby affirm that I have a certificate of CummLt to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec 3800,LaDCJ,' 1 r'-, ��\
Policy No. Companyy4pp 1-f 1
0 ❑ Certified copy is hereby furnished- FIRE SPRINK ENERGY T24
Z Z ❑ Cerif• ro i{ lite w' I the City ins ection division.
F-' p Applicant MISC.- REFER TO ORD. v N� v ❑ N�
ir W CE RT'I F I CATE OF EXEM PT1 ON FROM WOR K Ii RS' PERMIT ISSUANCE 10.00 /Q - FLOODZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
OL O (Phis section need not be completed if the permit is for one TOTAL �s Y� NEI Y N
::) Z hundred dollars($100)or less)
C) O 1 certify that in the performance of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,I shall not employ any person in any manner so as to
O Ed become subject to the Workers Compensation Laws of California.
IS. Doe Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ W NOTICE TO APPLICANT: If,after making this Certificate of Bx-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, ym most forthwith Comply with U FEE such provisions or this penAit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.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 issued(Sec. MICROFILM
3097,Civ.C). ) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
. 1 certify that 1 have read flus application and state that the above VENTILATION AN (SINGLE) 4.00
information is correct. 1 agree 10 comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 111
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU7 SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
(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
may in any way accrue a alost said 'ly in consequence of the PERMIT ISSUANCE 10.00
gr n i07toflhispe iL /� MECH.CONT. LIC.NO. MECH.
I �,() TOTAI 5C�
Signature of Applnt
' ant Coractor U e TOTAL
OFFICE COPY