12617 (2) POST THIS CARD NEAR FRONT OF BUILDING y
1 , IF,R MIT NUMBFR
CITY..0F CUPERTINO
INSPECTION DIVISION . 12617
'JOB INSPECTION RECORD;
PERMIT EXPIRATION
JOB ADDRESS '.'ZO-SB4 SUNRISE DRIVE - -- - LIN IT-f ' ' ' '' Lora -
_ PERMIT=EXPIRES•IF WORK
,r
OWNER EDMOUD ' L.;Z BROWN -CONTRACToR EDMOUD L., BROWN . IS, NOT STARTED WITHIN
INSPECTION DATE I-INSPE TOR INSPECTION RECORD 180DAYS OFPERMIT ISSU-
FOUNDATION wt_27 f-97, ovr�'�:e4,fe ,7tdsK ANCE OR 180 DAYS FROM -
LASTCALLED INSPECTION.
aFe - 'AlPuiTp'�e. or.
- PREGUNITE. ,11,L. .Io•`�'O-:/ .`Vg' .".SvL o/F! y PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 5 6VCIC 5 h0wCr, 6K
UNDERGROUND /SLAB.. , 'OA
PLUMBING'
ELECTRICAL - - �� v�11 •' -
n i'JI ISSUANCE DATE"
' MECHANICAL - r BL G. ELECT. PLG. MECH. ^
} I
c t l of C In.'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - - INFORMATION
VALUATION SIFT.
PLUMBING P
MECHANICAL- _ -
.
ERMIr rD
ELECTRICAL P
FRAMING • P^//- , - / I D� I•j— V
STORIES TYPE CONSTR.
IN CATION
1 OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
I
ROOF SO.FT FLOOR AREA TOTAL ACREAGE
77XII
DIAPHRAGM - /: ;? B, BUILDING USE
RES IND CON PB Otbe,
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 0 ,1:1 1-1
ASSESSORS PARCEL NO.
ROUGH
PLUMBING ° -
GAS TEST TRACT No. PARCEL NO.
MECHANICAL - Q^ 047
' -
ACC.DATE ACC.FILE NO.
1.
ELECTRICAL D- FINALS � 151-1-
SHEAR
INSP. -FRAMING lC-016 SAN #' ZONING ENG.SITE NDINSULATION PLUMBINGA'a _p' GAS.MECHANICAL FIRE SPRINK ENERGY T-2A
Y ❑ NE] Y0 N
COVER NO WORK U TIL ABOVE AS BEEN SIGNED HEATINGLATH-INTERIOR _19, ELECTRICAL FLOOD ZONE A.L U.C.
LATH-EXTERIOR (� g� '� FIRE DEPT. Y❑ , NOY �] NE]
SHEETROCK T ° 7 �6 GRADE FEE SUMMARY
SHEAR INTERIOR "• BUILDING EXTERIOR I ' TEMPORARY APPROVALS BUILDING J
FIREWALLS ELECTRIC PLAN,CHECK •
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE11
4 +
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
AR'RANG E•FORINSPECTION BY PHONING 252-4505, ELECTRIC
„ - _
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING' 4
PLEASE GIVE JOB ADDRESS WHEN.PHONING. x .
"— SEE PERMIT FO EXPIRATIONDATE MECHANICAL i ...
IMPORTANT! ''` coNsr rnx
,•
PLEASE READ REVERSE SIDE BEFORE `L '� TOTAL -• '-
CALLING FOR;FINAL.INSPECTION. ' '
OFFICE COPY A -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY
"`BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT..
AooREs
-�)UVIX ?-IS -DQ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL :1261 7
J+'rf1Y,v. OWNER'S ,/a - - •PLAN CH ECK VA LIGATION
NAME Tv QTY. ELECTRIC PERMIT FEE
4 EDYK QkA7b L. ,NE ZSS-/ s
'rCONTRACTORS;�`/k,..wbia• ' OUTLETS 00/1.00 /S--
NAME - - -
' 10.
LIC No '- - •LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
ADDRESS
, APPLIANCES=RESIDENTIAL 4.00
CO ,
PHONE I PANELS 10.OD O DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEERS '
'-LIC.No., SIGNS TRANS. 3.00
ARCH.OR ENO. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION'
ADDRESS `
- ZIP EMP.METER OR POLE INS.- 20.00 PAID
RPPLICA TE - MOTORS %E gE SCH.
SERVICE CHANGE . 20.00
0IF z 0'0 LICENSED CONTRACTORS DECLARATION 1C1{=I ??7777/s -.y
¢ u u I hereby affirm that I am licensed under provisions of Chapter'9 '' 1 N IS9 ANC'E'Drmel Lino
as (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT I PLG. I MECH.
i Professions Code,and my license is in full force and effect. 1 El ❑
z 0= License Class _ Lit,Number - �r'i`' y - IIx1
`.0 W r Date - Contractor ) 'T
a Y f r BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION. INFORMATION
DAO MISC.- REFER TO ORD
F
; ., I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
u 0 j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Q
rWCode:Any cityorcouity which requires a permit to construct,after,
¢¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC1/(L/�"o(. /
O¢. requires the applicant for such permit to file a signed statement that TOTAL LL�l a•PEaRMIT TO
whe is licensed pursuant to the provisions of the Contractor's License A.
F i i Law(Chapter 9(commencing with Section 70000ofDRision 3 of tilt
a - Business and professions Code)or that he is exempt therefrom and OTY, PLUMBING PERMIT FEE
IF r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR..
i ;m by any applicant for a permit subjects the applicant to a civil penally ' ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as I BACK FLOW PROTECT.DEV ICE 4.00 OCC.GROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sule•(Sce. 7044, Business and Professions I DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 �-•� ��',
,Code:.The Contractor's License Law does nod apply to on owner ol"
/" ployees,property who builds or improves thereon,and who does such work Z FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTALACREAGE
himself or through his own emprovided that such imro
pves
menti are not intended or offered forsale.11,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
a�
MMs^ or improvement is sold within one year of completion,the owner- GAS EA. OVER 4 IEA) 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Omar
0 1,as owner of the property,am exclusively conlmcting with - - ❑ ❑: ❑ ❑
licensed contractors;to conslructahe prgicct(Sec:7044,Business LAWN SPRINKLERS-1,INC 5 V.B. 6.00 - ASSESSORSPARCELNO.
` 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
ticontracts forsuch projects with a contractogs)licensed pursuant to SEWER-SANITARYV-STORM EA.200ft/10.00
the CmVractor's License Law. TRACT NO. PARCEL NO.
❑ la c tooter ST rl ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
n
cone D t - WATER SYSTEM 5:00 -
4, ACC.DATE ACC,FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIPII -'(, 1.5.00 '
I hereby affirm that 1'have a certificate ofe n cut to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation insurance,or a certified _ 1
copy thereof(Sec.3800,Lab.C.). , .F- 0cave,�
Policy No. � m
Copany -
O ❑ Certified copy is hereby furnished. p FIRE SPRINK ENERGY T;24
Z Z ❑ Certi Ucd copy Is filed with the city inspection dlvlsion.
M ISC.- 'REFER TO ORD.
O APPlicant s .V ❑ No V ❑ N❑
~ rn - PERMIT ISSUANCE 10.00 J FLOOD ZONE - A.L.U.C.
� CERTIFICATE OF EXEMPTIONNS FROM WORKERS' �]
W 7 .COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. O Y❑ N❑ - Y❑ N❑
� Z (This dollars
need not he completed If the permit is for one TOTAL
hundred dollen(S 1the pe form
LL O 1 certify that h the 1 niploy in of the work I'oewhitl,this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issuede I to the W rkers'y any person in any Inanner sro ns to. r rs t" -
U become subject to the Workers'Compensation Laws n1 California.
O w - r- t.l�
a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE ption,T'O APPLICANT: II',after making this Certificate Compensation
fix-
F.. ? emption,you should become subject to the Workers'CComply Willi qpP LIANCE 6.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C..) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
+ CONSTRUCTION LENDING AG1iNCY AIR HANDLING UNIT(OVER IO,OODC.F.Mlli.16i00 SEISMIC FEE -�
I hereby affirm that then, is a construction•lending agency lin EXHAUST HOOD IW ITH�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
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC (�
Len do is Ad dress - _ -
- I"certify ,hut I have read this application and stunt that the nbovu VENTILATION FAN (SINGLE) 4.00 - /� �.
information is correct. I agree to comply with nil city and roounly PLUMBING r„/- (��
'ordinances and state laws relating to,building construction, and BOILER-COMPI3 H.P.or100,000B.T.U.) 6.00
-re by authorize represematives of this city do enter upon lite - - Ory
e-mertioned property for inspection purpoxs. BOILER-COMP (Over 100,000 BTU.)SEE FEE SCH. MECHANICAL
agree to save, indenmify and keep Imaless the City of MISC.- REFER TO ORD.
F1,1 liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 Q CONST.TAX ..
way neer • ago' t nid•City in consequence of the
permi MECH.CONT. LIC.NO.- -S- TOTAL D/0 TOTAL / 5C�
t/Contractor Date
n
.;;� OFFICECOPY -