13680 (2) POST THIS CARD NEAR FRONT OF BUILDING
I'(IRMIT NUMBER
CITY OF CUPERTINO 13680
INSPECTION DIVISION
JOB INSPECTION RECORD e
PERMIT EXPIRATION
JOB ADDRESS 20343 STEVENS CREEK UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER DIVANI FURNITURE (DEPoNZRAcTPROPFRTIES) IS NOT STARTED WITHIN
INSPECTION DATE MSIGNED
INSPECTION RECOR 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION -� 'LASTCALLED INSPECTION.
UFER
PREGUNITE PER IT4y'n VTION
POUR NO CONCRETE UNTIL ABOVE HAS BE
UNDERGROUND /SLAB 61(�^ 1 �
PLUMBING - r'�`� 11Jv1'tfi�0g
ELECTRICAL _ ISSUANCE DATE ` ��'
MECHANICAL - SLOG. ELECT.I PLG. MECR,
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
` INFORMATION
WOOD FLOOR - vnwnrloN SIFT.
PLUMBING
MECHANICAL V
PEHMIT TO
ELECTRICAL _
FRAMING
STORIES TYPE CONSTR.
I INSULATION
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
_ 50.1'T FLOORAP[n TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
- _ HES IND CON PB 0111.t1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ '❑
ASSESSORS PARCEL NO.
- ROUGH ]
PLUMBING •gyp' TRACT NO, PARCEL NO,
GAS TEST
MECHANICAL - -To--
ACC.DATE ACC.FILE NO.
ELECTRICAL ,7 4^7 FINALS DATE INSP.
FRAMING SAN # '-
ZONING ENG.SITE NO.
INSULATION PLUMBING W
GAS
MECHANICAL --A
FIRE SPRINK ENERGY T.24
Y [] NEI v bI N(:],COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
• LATH-INTERIOR ELECTRICAL
FLOOD ZONE A.L,U.G.
LATH-EXTERIOR FIRE DEPT. (V_ 7 ❑ •N❑ Yo N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING D`I BUILDING #
SHEAR EXTERIOR TEMPORARY APP VALS '
FIREWALLSELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE i ^CJS
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED'INSPECT!ON• PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNsr.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING.FOR FINAL INSPECTION. TOTAL
OFFICE COPY t /
'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
, BUI LMNG PROJECT I DENTI FICATION PERMIT NUMBER
BU;L G APPLICATION & PERMIT
2os3 3 rvc�vs Cie L- 1 J 13680
BUILDING -'ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S DI 04 all F� PLAN CHECK VALIDATION
r "wME J YTII(ry/ Y. ELECTRIC PERMIT FEE
PHONE
NON AMERACTG s OUTLETS-SWITCHES-RECEP 10.00/1.00
uc,
CONTRACTORNO, LIGHTING FIXTURES 10.00/1,00
ADDRESS rr
RESIDENTIAL 4 �'�,fj J •:
Ess 's APPLIANCES .00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLA CHECK P P.C.NO.
GH PANELS (OVER 200 AMP) 20.00 /7yP^.( .0
ENGINEER
- LIC.NO, SIGNS TRANS. 3.00
ADDRESS E"G' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00 /1
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS /�/,/�,u"//�1
SERVICE CHANGE 20,00 0
,1�i8�')1
r o o LICENSED CON'I'RACI'ORS DECLARATION
Q Z I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w Q w (commencing with Section 7000)of Division 3 Of the Business and BLO ELECT. PLG. MECH.
H a, Professions Code,and my license is in full force and effect. ❑ ❑ ❑
o 0 H W License Class Lic.NumberT
Date Contractor
a m f BUILDING PERMIT
¢ o CE a U OWNER-BUILDER DECLARATION INFORMATION
K ;LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
_ u. oJ Law for the following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
wj Code:Any city or county which requiresapermit to construct, 45^'r'4 / 2
R ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. r {J�J b
wDLL requires the applicant for such permit to lite a signet statement that TOTAL PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License
FIQ
Law(Chapter 9(commencing with Section 7000)ofDivision3o(Ihe /A/7W-*,/00- �� ✓T"
4 c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 ) STORIES TYPE CONSTR. ,
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500t): 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. 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 improves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sp,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
mems are not intended or offered 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-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON, PB other
❑ 1,as owner Of the property,am exclusively contracting with . ❑ Q ❑
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
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 conlractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 '
the Contractors License Law. TRACT NO. PARCEL NO.
❑mulon f'tl lrp cr Sec.-.B.&P.0 for this WATER HEATER W/VENT 6.00
Owner Uat WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKER COMPENS PION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby at that I have a certificate of consent to self-insure, , ZONING ENG.SITE NO,
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.L
Policy Na.-Company
Q O Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Q Applicant Y N� Y 0 N[:]�' va PERMIT ISSUANCE 10.00
UJ - CERTIFICATE017EXEMPTION PROM WORKERS' FLOOD ZONE A.LO.C.
UJ d0 COMPENSATION INSURANCE PLO.CONTE. LIC.NO. TOTAL Y13 NEI Y [] N�
Z hundred
section need not be completed if the permit is for one
hu1 cert dollars IS 100)pe less)
U O 1 certify that h the performance of the work for which this per- OTV'. MECHANICAL PERMIT FEE FEE SUMMARY
0 F mil is issued,e I shed not employ any person in any manner so is to
Q w become subject to the Workers'Compensation Laws of California. //
CL Date-Applicant Applicant p - ALTER OR ADD TO MECH. 5.00 BUILDING
} N 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 10AMC.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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.l.
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 Certify omt 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
ordinances and state 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 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
may in a way true against sail City in consequence of the
grantin tis pc MECH.CONT. LIC.N0. MECH.
TOTAL TOTAL 2
Si ore of Ap cant/Contractor Ua O�
OFFICE COPY