13490 (2) POST THIS CARD NEAR FRONT OF BUILDING
' PRHMIT NUMRF:R
a CITY .OF CUPERTINO Qnn
INSPECTION DIVISION 1 13490
JOB INSPECTION RECORD
�0
3/ PERMIT EXPIRATION
TEVENS CREEK S
JOB ADDRESS - - UNIT# PERMIT EXPIRES IF WORK
OWNER DEANZA PROPERTIES CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR. INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE'OR 180 DAYS FROM
LIFERLAST CALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE ATE
MECHANICAL
" P`' � r�1*.'C•to ❑�; ''❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;; 'BUILDING PERMIT r`
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING -
MECHANICAL ,l 710
ELECTRICAL " - _, PERMIT TO /�J
FRAMING - r ll F°�/T IAA 1,1`4 0I/
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FI,FLOOR All" TOTAL ACREAGE
DIAPHRAGM
auILD usE
' RES IND CON
'PB Utlirr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ I] ❑ I]
ROUGH ASSESSORS PARCE L NO.
PLUMBING
GAS TEST
TRACT NO. PARCEL NO.
� .. '
MECHANICAL -
ELECTRICAL -, .FINALS •;:DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN tt '
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS'
FIRE SPRINK ENERGY T@4
MECHANICAL Y NCD v N�
COVER NO WORKUNTIL ABOVE HAS BEEN SIGNED , HEATING '
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT. Y❑ NE) Y F-1N❑
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
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM'
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
r ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TA*
PLEASE READ REVERSE SIDE BEFORE d
CALLING FOR FINAL INSPECTION. TOTAL
• OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BO I LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
aGILD'NG APPLICATION & PERMIT
AD°REB= 13490
�R th BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S 7 P PLAN CHECK VALIDATION
• NAME ,µt.x1 Pr4jN OTY. ELECTRIC PERMIT FEE
/ „V PHONE
CONTRACTOROUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.No, ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR CSS APPLIANCES-RESIDENTIAL 4.00
ADDRES
PHONE PANELS , 10,00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AM P) 20.00
ENGINEER PLAN CHECK FEE P.C.NO.
OR
uc.No. SIGNS TRANS. 3.00
AARCH,OR DDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT MOTORS SEE FEE SCH. � // _ 1
Lr. � /may-M'`l
SERVICE CHANGE 20.00 tP
0 0 o LICENSED CONTRACTORS UECLARA'NUN
Fi w 1 hereby affirm that I am licensed under provisions of Chapter 9 „s u`. C). l ISSUANCE DATE
to ¢A,. (commencing with Section 7000)of Division 3 of the Business and /BLDG. ELECT. PLG. MECH.
H w i' Professions Code,and my license is in full force and effect O
Z 0 m o Date License Class Lic.Number P1 A�
o H w Contractor -'Zi I lu��
¢ y f ' BUILDING PERMIT
¢ a w OWNER-BUILDER DECLARATION INFORMATION
X
;°'y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
uo¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
� - Code:Any city orcounty which requires a permit toconstrucl,alur,
> ELEC.CONTR. LIC.NO.
5 rt¢ improve,demolish,or repair any structure,prior m its issuance,also ELEC.
d -DLL
requires ic the dp pursuant
for SUCK permit to file a signed statement that TOTAL PERMIT TO
w$ he is licensed pursuant en the provisions of the Contractor's License �1
H i the
Q Law(Chapter 9(cosmos Code)or Secthat
is 00)exempt theref o and 11A1r6Wy /0,< �/L/j-IQp 1aG�
i D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE'
¢ H$ by basis for alleged exemption.Any violation of Section malty STORIES TYPE CONSTR.
by any applicant fora handrail
dollars(h500).)cannoacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEV ICE 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,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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improve-
rents are not intended orOffered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 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. 30.00 RES IND CON PS Omar
❑ I,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 no Lapply
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 contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT NO. PARCEL NO.
the Co
❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date6-g%fWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORT COM NSATION DECLARATION V WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a Certificate of consent to self-insure, 20NING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.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 inspectidn division. MISC- REFER TO ORD.
O Applicant Y❑ N❑ Y ❑ N❑
~ InPERMIT ISSUANCE 10.00
CL - CERTIFICATENEXEMPTION FROM CRS' FLOODZONE A.L.u.C.
W � COMPENSATION INSURANCE, PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL Y C] N[3Y [:] N❑
hundred dollars($100).,less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W tmit is issued,I shall not employ any person in any mannerso as to
U become subject to the Workers'Compensation Laws of California.
Go Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3� SD
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex
L.. Z emption,you should become subject to the Workers'Compensnti.n APPLIANCE 5.00 PLAN CHECK / 7.L
provisions of dhe Labor Code, you must forthwith comply with FEE 4
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 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
0 1 certify Ihat 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
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
above-mmdioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE BCH. MECHANICAL
(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 any ay accrue against said City in consequence of the
giant
i fit S ,mit MECH.CONT. LIC.NO. MECH.
XTOTAL TOTAL F3 7�
hi alum of Applicant/Contractor ate
OFFICE COPY