14698 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINOggg
4 INSPECTION DIVISION 1
JOB INSPECTION RECORD
. PERMIT EXPIRATION
JOB ADDRESS 22153 WALLACE DRIVE, _ UNIT# _Lor#
PERMIT EXPIRES IF WORK
OWNER John Shed CONTRACTOR Don Barcone IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION T�j _ -NOTE:
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLEDINSPECTION.
PR EGUNI?E TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. -
GARAGESLABS. -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL h ISSUANCE DATE
MECHANICAL 'aLDG. ELEcr PLr. IMECR
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
PLUMBING - vALunrioN s
MECHANICAL
ELECTRICAL D' PERMIT IQ
FRAMING
41,
FRAMING " - � /� w
INSULATION STORIES TYPE CONSTR
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE omv APCA roTAL Aca eneF
�. DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING use
ROOF SHEATHING Res IND CON Pe OM.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ❑ ❑ ❑. ❑
ASSESSORSPARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ` ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
CONING ENC.SITE NO.
. INSULATION - PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T 24
MECHANICAL y ❑• Nr ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOOZONE A L U C
EXTERIOR SHEAR ELECTRICAL RELEASE
Y ❑ N❑
INTERIOR SHEAR � FIRE DEPT. L N❑,
SHEETROCK GRADE FEE SUMMARY
. EXTERIOR LATH BUILDING .
INTERIOR LATH TEMPORARY APPROVAL BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
•'y';i�, � ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. rLLPLUMBING o� PLEASE GIVE J08 ADDRESSWHEN PHONING.
z
- 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 -
BUILDING PROJECT I DENT[FICATI ON PERMIT NUMBER
BUILDING . APPLICATION & PERMIT 14698
r ADDRESS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME �,^' , �ry7
e4 PHONE737-/9
• QV✓N .ef iJ QTy' ELECTRIC PERMIT FEE
coMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
�t
_6E
LIC.NO.�7O�0f LIGHTING FIXTURES 10.00/1.00
oDons
ADDRESSRESS PPLIANCES-RESIDENTIAL 4.00
p
,0 - C OrvE S/-"9Y� PANELS 40.00 - DATE OF APPLICATION
ogcHlTecT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS BNc. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. .' 20.00 ^
Ars
aDDRoRESSss MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
w
00 LICENSED CONTRACTORS DECLARATION E
a v I hereby affirm That I am licensed under provisions of Chapter 9 ANCE DATE
(conuneneing with Section 7000)of Division 3 of the Buainess und.
<U0
^�, G. : ,ECT. PLG. MECH.
F O z Professions Cod ad my license is in full force and effect ❑ ❑ ❑
z O Q- A Licen C'; Lic.Number
O z H W� Dale Contractor
in
a y fILDING PERMIT
¢ ¢ 4 OWNER-BUILDERDECLARATION
cii u INFORMATION
w; w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
_F u a-O J Law Port the following reason.(Seo.7031.5,Businessund Professions pERM1T ISSUANCE 10 80 VALUATION $/FT.
,A� Code:Any city or county which requires a permit to construct,alter,
2 5 Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. r
u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
M
m he is licensed pursuant 1.the provisions of the )Contractor'sofDivision 3 License
H z i Law(Chapterand
Professions
de)with Section 7000)ofDivision the therefrom
and
a Nosiness and Professions Cude)or that he is exempt therefrom und QTY. PLUMBING PERMIT FEE
M r o the basis for Ilmeallugcd exemption.Any violation of Seeliun 7031.5 STORIES TYPE CONSTR.
n ;m by any applicant lbr u permit subjects the applicant to civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 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 011e structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business :cod Professions DRAINS-FLOOR,ROOF,AR EA,COND, 5.00
Cade:The Contractor's License Law times not apply to an owner of
property who builds or improves thereon,and who docs etch work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through lits own employees,provided that such improve-
mentsarenot intended or ffered for sale.IL however,the building GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 200
builder will have the burden of proving that he did not build or im- . BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Other
C I,as owner of the property,am exclusively contracting with . .
licensed contractors to construct Ilene project(Sec.7044,BusinessLAWN SPRINKLERS- 1 INC 6 V.B. 8.00 ASSE550RSPARCELNO-
and Professions Code;The Contruclor'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 contractors)licensed pursuant t. SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,I1.&P.C.for Ibis WATER HEATER W/VENT 6.00
rrosnn
Owner Life 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 consent to self-insure,
or a certificate of Workers'Compensation Insuratic ora erlifted ZONING ENG.SITE NO.
copy thereof(Sec.31100,Lxb.C.�i. n �`
Policy No. ' Company
O ❑ Certified copy is herebyfoorl:hed' FIRE SPRINK ENERGYT YC
P:Z Z ❑ Ceri 'Applicant ,n �7�d�I'w-t.h`the city inspection division.
k� -~1 MISC.- REFER TO ORD.
N
Q ` V V 0 NNE)ut PERMIT ISSUANCE 10.00
Lu - CIiRT'Il9CA'ITi OI'IiATION INS PROMWORKIiRS' 'FLOOD ZONE A.L.U.G.
W > COMI'fiNSATION INSURANCE PLG.CONTE. LIC.N0. PLG.
CL Z (This section need not he completed if the permit is for one TOTAL Y[:] IN Y'� N�
hundred dollars IS 100).,less.)
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y Date' ' ApplicantALTER OR ADD TO MECH. 5.00 BUILDING Jf
} N NOT'IC17 'PO APPLICANT. If,after making'Ihis Certificate of fix- -
F 2 emption,you should become subject to the Workeri Compensal ion APPLIANCE 5.00 PLAN CHECK
Provisions cf.the Labor Code, you must forthwith comply with FEE
U - such provisions.r this permit 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 SO
I hereby affirnm that there is a canslmcti.n lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the purlormance.of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.0.). 'HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC
I eerily that I have read this application and state than the above VENTILATION FAN (SINGLE) 4.00
information n correct I agree to comply with all oily and county BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stole esen ativesng to building c0nstflleupon and
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes. BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. 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 way accrue against said City in consequence of the
amlingoff " permit, MECN.CONT. LIC.NO. MECH.
OTA, TOTAL
gnaturc of Applicant/Contractor Uate
OFFICE COPY