23417 PERMIT NO. ISSUED BY DATE BUILDING PERMIT APPLICATION OWNER-BUILDER DECLARATION LICENSED CONTRACTOR DECLARATION
COUNTY OF SANTA-CCARA BUILDING INSPECTION OFFICE .j I herebyaNlrm under penalty of
p y perjury that i am exempt from the y penalty of perjury that I am licensed under
70 W.HEDDING ST.SAN JOSE,CA 85110I hereby affirm under Contractors License Law for the fallowing reason(Sec.7031.5, provisions of Chapter 9(commencing with"Section 7000 of Division 3 of
,)\\ JO ADDRESS Business and Professions Code:Any city or county which requires a p ( g )
GEOLOGY the Business and Professions Code,and my license Is In full force and
,1 f1 C� permit to construct,alter,Improve,demolish,or repair any structure,
1, 0"�� \-� Q V`e U e �7u( prior to Its Issuance,plso requires the applicant for such permit to file effect. p
1V4 CITY ZIP a signed statement that he or she Is licensed pursuant to provisions License Class N Llc.No.
CLEARED FOR ISSUANCE BY DATE of the Contractors License Law(Chapter 9(commencing with Section
NEAREST RO S STREET ❑ INSPECTION REQUIRED P 7000)of Division 3 of the Business and Professions Code)or that he
F'({� O FINAL INS TION. or she is exempt therefrom and the basis for the alleged exemption. Contractor Date
PLANNING Any violation of Section 7031.5 by any applicant for a permit subjects
- C3 Stir�'-X337 the applicant to a civil penally of not more that five hundred dollars ON TR t TION LENDINGAGENCY
OWNER PHONE
T 4 (5500).):
'�, ¢67-036 SET BACK(FE'):'R SIDE REAR Thereby affirm under penalty of perjury that there Is construction
�- 1,as owner of the property,or my employees with wages as their lending agency for the performance of the work for which this permit is
MAI NG ADDRESS I Oqq S gam)P11e ZONE: t'l sole compensatlon,will do the work,and the structure Is not Issued(Sec.3097,Civ.C.)
ry l Intended or offered for sale(Sec.7004,Business and Professions
Y CITY CV f��•v`O GJ. ZIP �('S�1•¢ CLEARED FOR ISSUANCE BY
V4 `DATE Code:The Contractor License law does not apply to an owner of Lender's Name:— p
property who builds or Improves thereon,and who does such
ARCHITEC ENGINEER ❑ INSPECTION REQUIRED PRIOR TO FINAL INSPECTION. work himself or herself or through his or her own employees, Lender's Address:
M provided that such Improvements are not Intended or offered for
MAILING ADDRESS (•c•S�`I.5 9-Ar,ne J - LAND DEVELOPMENT ENGINEERING&SURVEYING sale.If,however,the building or improvement Is sold within one I certify that I have read this application and state that the above
that h
year of h or she did not build or Improve for the purpose information Is correct.I agree to comply with all city and county
Ir
CITY
ag v�p ZIP of sale) ordinances and state laws relating to building construction,and hereby
.-SIUCENS J. NO.
EAPHONE authorize representatives of this county to enter upon the above-
CLEARED FOR ISSUANCE BY DATE ❑ 1,as owner of the property,am exclusively contracting with menti property r ns n purposes. 2
❑ ROAD IMPROVEMENTS licensed contractors to construct the project(Sec.7044, �` 6
CONTRACTOR hR Business and Professions Code:The Contractors License Law cil
❑ DWY APPR. does not apply to an owner of property who builds or Improves Slunature of Aoollcam or Aaent Date
thereon,and who contracts for such projects with a contractor($) HAZARDOUS MATERIALS
MAILING ADDRESS ❑ OTHERS licensed pursuant to the Contractors License Law.)
(FOR NON-RESIDENTIAL ONLY)
CITY Ste`w. ZIP ❑ INSPECTION REQUIRED IOR TO FINAL INSPECTION. ❑ I am exempt under See. Indicate II the Intended occupancy will use hazardous materials.
Initialing Yes acknowledges that H&S Code Sections 25505,25533,and
CLASSILICENSE NO. PHONE ROADS&AIRPORTS [D 25534 as well as filing directions were made available to you.
LOTlfRACT ApN 7 3 Owner Date 2 O
❑ Yes
�•�--•• ,�\/�(J I_ `-"�l\ CLEARED FOR ISSUANCE BY: DATE ❑ No
PLAN CHECK NO. PLAN CHECKER CODEYEAR ❑ RD IMPROVEMENTS WORKERS'COMPENSATION DECLARATION CASHIER'S VALIDATIONS
I hereby affirm under penally of perjury one of the fallowing
TYPE OF IMPROVEMENT: REROOF ❑ DAVY APPR• declarations:
❑ INSPECTION REQUIRED PRI TO FINAL INSPECTION. ❑ 1 have and will maintain a Certificate of consent to self-insure for
DUI ADDITION ALTERATION REPAIR MOVE CONVERT MOLISH workers'compensation,as provided for by Section 3700 of the
'AREA STORIES DWELLING ENVIRONMENTAL HEALTH Labor Code,for the performance of the work for which this
permit Is Issued.
❑
PERMIT NO. OCCUPANCY TYPE OF CONSTRUCTION "`I++'�"'+' ""t�•�' "`t'""'�`1 have and will maintain workers'compensation Insurance,as u r r Lir s+� °•qui / c:ui r:t:,.�
CLEARED FOR ISSUANCE BYDATE required by Section 3700 of the Labor Code,for the performance CI?: ;y0;_
JOB DESCRIPTION `-, �1 of the work for which this permit is Issued.My workers' +~n+mint ,-�n-:,,r r�+ ,��•�
�r� E (� El MATERIALS compensation insurance carrier and policy number are: u r us uc .- ,u:,'i L-uaii,i+
❑ WATER SYSTEM PERMITar , �,,,, -r,_•
Carrier �(iu,i _,i,+ ruv u-_l..,u Wo
Policy Number iii.:ur�uC =,��i ii i�uat,�i�r�
❑ SEPTIC SYSTEM PERMIT a (This section need not by completed If the permit Is for one vuL; ri.e. •r.f n�
❑ INSPECTION REQUIRED IOR TO FINAL INSPE ION. hundred dollars($100)or less) �R '
1 certify that In the performance of the work for which thisw r,:.uA uL ••su:l i a n,r•Tu
FIRE MARSHAL permit
Is Issued,I shall not employ any person In any manner so as to u�:.:st:u r�:+.r,+.,,•,., uu
become subject to Abe workers'compensation laws of Callfomla,
COUNTY FILE NO. and agree that H I should become subject to the workers'
CLEARED15R ISSUANCEDATE compensation provisions of Section 37DO of the Labor Code,l
500 SCALE MAP NO. ❑ INSPECTION REQUIRE OR TO FINAL INSPECTION. shall forthwith
comply with those provisions.
,, -f
VALUATION /1/"1/�'t SPECIAL INSTRUCTIONS Applicant
PLFEEA NING__ 7S.M.I.P. 00 oc� r� WARNING:FAILURE TO SECURE WORKERS,COMPENSATION
ce
COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO
FIRE MARSHAL SEPTIC CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
q�7 ,/ ,,^ THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF
PLAN CHECK 7lf PERMIT�/��� (>,(D 5!+'v.��.C'(� D OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
CO PENSATION,DAMAGES AS PROVIDED FOR THE SECTION 3705
¢TREK, � O(�E�NR• P(�-(ZP� €=cREI1lI
Inspection Data Sheet - 3/19/2004
Permit 2002-23417-00 BEMP Issued 9/27/2002
Location 10495 BYRNE AVE, CUPERTINO, CA Zone 2 Fees
Cross Street MC CLELLAN Building 440.00
Owner TORRES, DAVID J Electrical 50..00
PlanCheck 330.00
Contractor OWNER Planning 251.00
Owner Phone 861 -0363 SMIPCat1 3.00
Job Desc NEW DETACHED GARAGE\SHOP 1000 SF Mechanical 40.00
Plumbing 87.00
❑Geology ❑Land Develop ❑Planning ❑Roads/Airports ❑ Environ Health ❑Fire Marshal ❑
Called Date Insp Phone Code 1 2 3 4 5
Request 3/18;04 7:14:23 AM 3/19/.04 40€5958379 ST16 0 0 0 0
Code Comments Date Insp Disposition
EL01 UFER-GROUNDING 3/24/03 DMC Approved
ST02 FOUNDATION FORM/REBAR Looks ok, but need setback letter 3/24/03 DMC Partial Ap
EL01 UFER-GROUNDING 3/24/03 DMC Approved
ST02 FOUNDATION FORWREBAR Looks ok, but need setback letter 3/24/03 DMC Partial Ap
EL01 UFER-GROUNDING Approved
ST02 FOUNDATION FORWREBAR Looks ok, but need setback letter Partial Ap
PL03 PARTIAL PLUMBING 5/13/03 DAH Approved
ST07 GIRDERS& 5/13/03 DAH Approved
JOISTS/UNDERFLOOR
ST02 FOUNDATION FORM/REBAR Per DMC 5/16/03 MAG Approved
ST16 OTHERS Survey Itr recvd 5/16/03 MAG Approved
ST08 INSULATION-UNDERFLOOR 5/16/03 MAG Approved
ST02 FOUNDATION FORWREBAR Per DIVIC 5/16/03 MAG Approved
ST16 OTHERS Survey Itr recvd 5/16/03 MAG Approved
ST08 INSULATION-UNDERFLOOR 5/16/03 MAG . Approved
ST02 FOUNDATION FORM/REBAR Per DMC 5/16/03 MAG Approved
ST16 OTHERS Survey Itr recvd 5/16/03 MAG Approved
ST08 INSULATION-UNDERFLOOR 5/16/03 MAG Approved
ST16 OTHERS No one at site no permit 10/31/03 GRF No Action
ST10 ROOF NAILING/SHEATHING 11/3/03 DMC Approved
ST09 SHEAR NAILING All,but interior of double shear wall 11/3/03 DMC Partial Approval
EL04 ROUGH WIRING No second meter approved. 12/9/03 APA Disapproved
ST03 SLAB Garage 1/9/04 DMC Approved
EL04 ROUGH WIRING 2/10/04 DMC Approved
printed 6/3/2005 10:37:17 AM page 1
' Inspection Data Sheet - 3/19/2004
Permit 2002-23417-00 BEMP Issued 9/27/2002
PI-04 ROUGH PLUMBING 2/10/04 DMC Approved
ME11 SHEETMETAUDUCTS Correction 2/10/04 DMC Disapproved
ME11 SHEETMETAUDUCTS per corr. 2/17/04 DAH Approved
ST09 SHEAR NAILING 2/17/04 DAH Approved
ST12 INSULATION-WALL 2/17/04 DMC Approved
ST13 INSULATION-CEILING 2/17/04 DMC Approved
ST11 ROUGH FRAME/HOLD DOWN 2/17/04 DMC Approved
ST15 STUCCO WIRE/LATH 2/24/04 DAH Approved
ST14 SHEETROCK NAILING 3/10/04 DMC Approved
EL04 ROUGH WIRING 3/19/04 DMC Approved
ST11 ROUGH FRAME/HOLD DOWN 3/19/04 DMC Approved
ST12 INSULATION-WALL 3/19/04 DMC Approved
ST13 INSULATION-CEILING 3/19/04 DMC Approved
printed 6/3/2005 10:37:17 AM page 1
PERMIT NO. ISSUED BY DATE ti� BUILUINQ PERMITtARPL'IGA�'ION t +' OWNER-BUILDER DECLARATION LICENSED CONTRACTOR DECLARATION
CDUNTY t]F SANTA,CDARA EWILDINQ INSp CTICN DFFI�Iy
L -1 hJ y0�Vt HEDDINQ ST�SAN JO EV
CA 95110 I hereby affirm under penalty of perjury that I am exempt from the I hereby affirm under penalty o1 perjury that 1 am licensed under
.YaContractors License Law for the following reason(Sec.7031.5, provisions of Chapter 9(commencing with Section 7000)of Division 3 of
DDRESBusiness and Professions Code:Any city or county which requires a
GEOLOGY the Business and Professions Code,and my license Is In full force and
C permit to construct,alter,Improve,demolish,or repair any structure, effect.prior to Its Issuance,also requires the applicant for such pgrmit to file ,
CITY ZIP a signed statement that he or she Is licensed pursuant to provisions License Class Llc.No.
C�4 -V\ J,O CG qS p iA CLEARED FOR ISSUANCE BY V DATE of the Contractors License Law(Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code)or that he
NhAHt:5T GKV55 STREET ❑ INSPECTION REQUIRED PRIOR TO FINAL IN ECTION. or she is exempt therefrom and the basis for the alleged exemption. Contractor Date
Any violation of Section 7031.5 by any applicant for a permit subjects
PLANNING .. ` the applicant to a civil penally of not more that live hundred dollars CONSTRUCTION LENDING AGENCY
OWNER PHONE ($SOD).):
C_r� ar SET BACK(FEET):FRONT SIDE REAR ,,p I hereby affirm enc under penally of perjury that there Is a construction
Q•.>�\�y ®('r{„�j `� 7 17 U3� �g I,as owner of the property,or my employees with wages as their Ientling agency for the performance of the work for which this permit Is
'�qsC e y-` ZONE: sole com nsatlon,will do the work,and the structure Is not Issued Sec.3097,Clv.C.
MAILING ADDRESS i7- Pe ( )
Intended or offered for sale(Sec,7044,Business and Professions
w� CLEARED FO ANCE BY DA Code:%e Contractor License Law does not apply to an owner of Lender's Name:
CITY 'e ZIP ( property who builds or Improves thereon,and who does such
ARCHITECT/N N Ef�� ❑ INSPECTION REQUIRED PRIOR TO FINAL INSPECTION. work himself or herself or through his or her own employees, Lender's Address:
9 t`I_'%V1 provided that such Improvements are not Intended or offered for
sale.If,however,the building or Improvement Is sold within one
MAILING ADDRESS 7a�a- Q^ VJ, ,n LAND DEVELOPMENT ENGINEERING 6 SURVEYING year of completion,the owner-builder will have the burden of I certify that I have read this application and stale That the above
?l` Od- proving that he or she did not build or Improve for the purpose Information Is correct.I agree to comply with all city and county
CITY Ctywrv� V�\ CV` ZIP •��� of sale.) ordinances and state laws relating to building construction,and hereby
authorize representatives of this county to enter upon the above-
CLASSILICENSE N0. PHONE ¢' CLEARED FOR ISSUANCE BY DATE ❑ 1,as owner of the property,am exclusively contracting with menti one property l0 1 specl[on purposes.
-AD`b, 3-&v?_009 licensed contractors to construct the project(Sec.7044,
CONTRACTOR ❑ ROAD IMPROVEMENTS Business and Professions Code:The Contractors License Law Y tc) 4.a
3
Q i�2 C ❑ DWY APPR. does not apply to an owner of property who builds or Improves Slonature of Acoiirant o aent Date
thereon,and who contracts for such projects with a oonlractor(s) HAZARDOUS MATERIALS
MAILING ADDRESS G ❑. OTHERS licensed pursuant to the Contractors License Law.) (FOR NON-RESIDENTIAL ONLY)
CITY ZIP ❑ INSPECTION REQUIRED PRIOR TO FINAL INSP TION. ❑ 1 am exempt under Sec. Indicate ff the Intended occupancy will use hazardous materials.
Inlllaling Yes acknowledges that H b S Code Sections 25505,25533,and
CLASSILICENSE NO. PHONE -jog rQ���?�`7 a. _�" ROAO$SAIRPORT$. 25534 as well as filing directions were made available to you.
LOTITRACT [AP N Owner at..
2
❑ Yes
CLEARED FOR ISSUANCE BY: DATE ❑ No
PLAN CHECK. PLAN CHECKER CODEYEAR
❑ RD IMPROVEMENTS WORKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following
CASHIER'S VALIDATIONS
TYPE OF IMPROVEMENT: REROOF ❑ DWY APPR' declarations:. ,=.I=-, ,••-.1-,.r „ -ern,^+
1 of C..l:- —..v.1 it VIII Y,,I J,:•i
❑ INSPECTION REQUIRED PRI TO FINAL INSPECTION. ❑ I have and will maintain a certificate of consent to self-Insure for
BUILD ADDITION ALTERATION REPAIR MOVE CONVERT DEMOLISH workers'compensation,as provided for by Section 3700 of the
AREA STORIES DWELLING UNITS - - Labor Code,for the performance of the work for whish this •.�•^Y•'•=,^+n-^,^.^-n-^^•
„ENY.ONMENTALHEALT._ ,-..,., _
.:... .. .... permit Is Issued.
PERMIT NO. OCCUPANCY TYPE OF CONSTRUCTION ❑ I have and will maintain workers'compensation Insurance,as `•`� ��"' _
CLEARED FOR ISSUAN BY DATE required by Section 3700 of the Labor Code,for the performance
JOB DESCRIPTIO of the work for which this permit is issued.My workers' --s•
r-(j� I I I ❑ HAZARDOUS M ERIALS compensation Insurance carrier and policy number are: •• _ i- •� •� -r=-a'"-" '
=t
r ❑ WATER SYST PERMITa
Carrie --,_. =a•� v
❑ SEPTIC BY MPERMITa Polley Number �,'ii�•.u� ,. ,
')-( (Title section need not by completed H the permit Is for one
❑ INSPE REQUIRED PRIOR TO FINAL INSPECTION.
hundred dollars($100)or less)
10 1 certify that In the performance of the work for which this permit
FIRE MA.::, - .. .
RSNAb'��.., ��': Is Issued,lshall not employ any person In any manner so as to
- become subject to the workan'compeneatlon laws of CalHomW,
COUNTY FILE NO. and agree that H I should become subject to the workers'
CL EA D FOR ISSUANCE BY DATE eompensatlon provisions of Section 3700 of the Labor Code,l
500 SCALE MAP NO. ❑ NSPECTION REQUIRED PRIOR TO FINAL INSPECTION shall forthwith ncomply with those provisions.
VALUATION _ SPECIAL INSTRUCTIONS - - Applicant 4CX 1 Date w a�-�1�J
FEES ^^ 1
PLANNING &�1<Q S.M.I.P WARNING:FAILUREWF SECURE HALL SUBJECT
AN EMPLOYER
COVERAGE ISUNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
FIRE MARSHAL .,/� SEPTIC - THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF
.PLAN CHECK c 1 1 PERMIT COMPENSATION,DAMAGES AS PROVIDED FOR THE SECTION 3706 .
OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
OTHER
sev.ao.
PERMIT NO. ISSUED BY DAT / MECHANICAL PERMIT FEE PLUMBING PERMIT FEE ELECTRICAL PERMR FEE
Z I n� f) �O lv REM NO. R3 REM NO. REM
ISSUANCE FEE(ISSM ISSUANCE FEE(ISSPL) ISSUANCEFEE(ISSEL)
SERVICE HOURLY RATE ISPM SERVICE HOURLY RATE(ISPPL) - - SERVICE HOURLY RATE(ISPEL) '
. EXPRESS PLAN CHECK FEE EXPRESS PIAN CHECK FEE(EP) .. EXPRESS PLAN CHECK FEE(EE)
MECHANICAL/PLUMBINGIELECTRICAI.PERMIT PERMIT�IPTME) PERMIT FEE(PTPQ PERMIT FEE FrELo) GARNVAREHSE(PTELM
SANTA CLARA COUNTY BUILDING INSPECTION OFFICE (Complete Mechanical System for new single, (Complete Plumbing System for new single, (Complete Electrical System for new single;
70 W. HEDDING ST..SAN JOSE.CA 95110 multiple family structures and additions Z 500 sq.ft.) multiple family structures and additions L 500 sq.fl.) multiple family structures and additions i 500 sq.ft.)
Installation,relocation,repairor alteration of each forced- Each plumbing fixture or trap or set of fixtures one Temporary pole or meter set(TPM)
air or gravity-type furnace or burner,including ducts and -trap (PL7) Light outlets 1.10 min.(min.Yee)(0)
JOB ADDRESS vents attached to each appliance,up to and including Each building sewer(SEWER) - Receptacles
100,000 B.T.U.'s(FAVI) Each on-site sewer system(SEPTIC) I Switches jOver 10,ea.Addit.(1-4)
Over 100,000 B.T.U's(FAU2) Each water service(WATER) Light Fixtures:
'oARR5- I�.,Coe ` Floor furnace,suspended heater,recessed wall heater or Each on-site water service system(WELL) 1.10.(minimum fee)(1-7) .
CITY ZIP J floor mounted unit heater,Including vent(MTU) Moved building MOVEPL) Over 10,each additional(1-2)
Ci9 (Or replacement ol)appliance vent installed and not Each water heater and/or an as vent(WATE83) Heater(per kw)(HEATER)
NEARES CROSS ST. APN# included in an a liance rmit(FRNV) Propane tank(PROPAN) 4 RangelovenPo er/water heater(RODWH)
Registers,diffusers and grilles(Ind.duds) (FRNR)' - Gas Test PaneVpanel boardlswitchboard(PBSB)
Alteration or repair of forced air duds(FRNA) Each gas piping system,natural,or LPG; Service:change,repair or well
OWfR `J� PHO a2- -Installation or relocation of each bofler or Compre t r: One to five outlets,(GP31) too amp or less(SERV1)
To and including 3 hp(BCI) Over five,each additional(GPS2) )
MAILING ADDRESS 1���� Yr ire P Over 3 hp to and including 15 hp(BC2) Each Installation or repair of water,soil was , 400 p to 000 amp(SERV3)
Over 30 hp and including 50 hp(1103) and vent system(RWILp or more(SERV4)
CITY Cu �t`� CV` Zip Q�I-k Or absorption system-to and Incld.100,000 .U.'s(BC4) 'Each rept of a single dwelling(RWL2 Moved building MOVEE)
Over 100,000 to and Including 500,000(B ) Each Industrial waste pre-treatment ante ptd, Motors-112 hp or less(MI) Tramrormers-112<(T1)
Over 500,000 to and Including 1,000,000 6) including its trap and vent,excepfing k en type grease 112 to<5 hp(M2) 112 to<5 kva.(T2)
CONTRACTOR Over 1,000,000 to and including 1,750,0 (BC7) interceptors.funclioning as fixture trap (WASTE2) 5 to<25 hp(M3) 5 to<25 kva(T3)
t�1J\ (Refrigeration compressor over 50 hp or bsorplion Each rainwaters stem- r drain(RA ) - 2510<100 hp(M4) 25 to<100 kva(T4)
MAILING ADDRESS system over 1,750,000 B.T.U:s) Vacuum breakers or bade flow prat a devices on - Over 100 hp M5) Over 100 kva(TS)
For refrigerating system ratings one ho war,one tanks,vats,lawn sprinkler systems, to.,or for Solar system(SOLREL)
CITY ZIP ton or 12,000 B.T.UJh shall mean th same quantity. Installation on unprotected plumbs fixtures: Swimming poolslSpa:
Heat pump: - One to five(VACII) Private(SWELPR)
CLASSILICENSE NO. PHONE To and Including 3 tons(HTP1) Over five,each additional AC Public(SWELPU)
Over 3 tons(HTP2) Solar' stem(SOLRPL Signs(SIGNEL)
Moved building MOVEM Septic Tank Abatement.(STA) Sign transformers T6
.lob Desc6ption: cvl1, fy�J i fie, n Air-handl' unit over 10,000 e.f .(AIR) Gas Meter Set(GMS) - Festoon lighting:
Vent fan QT V ew 1�V�e` 3�+ We, Ventilation ceded hi a single p (FAN) � � Grease Trap(G � � � 200 lamps or less 7)
system which b no a portion of any heating� Each condensate.waste'and/ indirect drain line CWDL) Over 200 lamps(L7
Q or air conditionings stem au orized b a nett(VS) Each lilt station(LIFT) Special Circuits(CIRC
b�L� Installation of each hood whis.served.by'mechanlcal Swimming poolslSpa: .Electric Welder(per kva EW
exhaust,Including ducts for ood(HOOD) Private(SWV,PLPFQ Mercury vapor lamp(LO
1^!e Appliancelpiece,of equlpm t not classified in other Publid(SVJPLPU Electrical Appliance or piece of equipment not listed
,!�.e�•'t� ��a,,,,., appliance categories,or f which no other fee Is listed Each ehemoal wastepip!*s stem( Inlet(CHEM? in categories above,or for which no other fee is lis
-'1 vCS�e a- % Q_ See Fee Schedule for oll categories(APPOTH). p
h chemical waste abnenl system(CHEW) (See fee Schedule)(EAPP)
Each Steam and Hot W er Piping System(SHWPS) di chemical west.vaulting.and/or secondary TA
Heating or Cod' Cc COIL1 containment CASHIER'S VAI ITION$e _�+A M,•,. G
Installation of each t water and/or chilled water tan h system and/ hot water'piping(hydronic(PSHW +!a-rP r '.cop unit,Include du within unit jIndude condensatenges,Ovens& as L hter In Fireplace(GAS5drain)(COIL2 kce of water- ating.or water using equipmentEeeh roduct a in ventAatkln tem(CVS softener,ate (NIT �COMPLETE BACK OF PAGE. fke Damper swasher(DI
One b five, ,its(FDI) ...
Over five, ach additional(FD2
PERMIT EXPIRATION: PERMIT EXPIRES IF WORK IS
NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE
OR 180 DAYS FROM LAST APPROVED INSPECTION. SUBTOTAL SUBTOTAL
Rev. 11/02
Inspection Data Sheet - 3/19/2004
Permit 2003-23417-02 E Issued 1/14/2004
Location 10495 BYRNE AVE, Cupertino, CA Zone 2 Fees
Cross Street MC CLELLAN Electrical 85.00
Owner TORRES, DAVID J
Contractor OWNER
Owner Phone 861-0363
Job Desc Relocate electrical service to new garage and upgrade
to 400 amp,
❑Geology ❑Land Develop ❑Planning ❑Roads/Airports ❑Environ Health ❑Fire Marshal ❑
Called Date I.nsp Phone Code 1 2 3 4 5
Request 3/18/'04 7:1-4:23-AM 3/19/04 4085958379 ST16 0 `0 0 0 I
Code Comments Date Insp Disposition
EL1 1 UNDERGROUND Conduit between house and new service 3/10/04 DMC Approved
location.
printed 6/3/2005 10:37:42 AM page 1
PERMIT NO, ISSUED BY DATE BUIL�)N�,RFtRMIiAPPLICATIONt OWNER•BUILDER DECLARATION LICENSED CONTRACTOR DECLARATION
` COUNTY;OF SANTA.CLARA 13UILDINQ INSPECTION OFFICE I hereby efftrm under penalty of penury that I am exempt from me
l/Lv pC �/f v "70 W,HIE0DINO ST�.SAN JOSE CA:.B5110 _ I hereby affirm under penally of perjury that I am licensed under
Contractors License Law for the following reason(Sec.7037.5, provisions of Chapter 9(commencing with Section 7000)of Division 3 of
u08 DRE GEOLOGY Business and Professions Code:Any city or county which requires a the Business and Professions Code,and my license Is In lull torte and
permit to construct,alter,Improve,demolish,or repair any structure,
i t QS T,� vie prior to Its Issuance,also requires the applicant for such permit to Ills effect.
J CITY ZIP a signed statement that he or she Is licensed pursuant to provisions License Class Llc.No.
/l`bf CLEARED FOR ISSUANCE BY ATE of the Contractors License Law(Chapter 9(commencing with Section
J J 7000)of Division 3 of the Business and Professions Code)or that he
NEAREST CROSS STREFT ❑ INSPECTION REQUIRED PRIOR TO FINAL INSPECTION. or she Is exempt therefrom and the basis for the alleged exemption. Contractor Dale
9C 2{\ate PLANNING Any violation of Section 7031.5 by any applicant for a permit subjects
CONSTRUCTION LENDING AGENCY
the applicant to a civil penally of not more that five hundred dollars
OWN R PHONE ($500).):
oG t r�•� / SET BACK(FEET):FRONT SIDE AR I hereby affirm under penalty of perjury that there Is a construction
1^V�[D� ZONE: Eir 1,as owner of the property,or my employees with wages as their lending agency for the performance of the work for which this permit Is
MAILING ADDRESS -sola compensation,will do the work,and the structure is not Issued(Sec.3097,Civ.C.)
Intended or offered for sale(Sec.7044,Business and Professions
\ , CLEARED FOR ISSUANCE BY DATE Code:The Contractor License Law does not apply to an owner of Lender's Name:
V CITY ZIP property who builds or Improves thereon,and who does such
ARCHITECT/ENGINEER ❑ INSPECTION REQUIRED PRIOR TO FINA NSPECTION, work himself or herself or through his or her own employees, Lender's Address:
provided that such Improvements are not Intended or offered for
MAILING ADDRESS LAND DEVELOPMENT ENGINE ING&SURVEYING sale.If,however,the building or Improvement Is sold within one I certify that I have read this application and state that the above
year of completion,the owner-builder will have the burden of pp
proving that he or she did not build or Improve for the purpose Information Is correct.1 agree to comply with all city and county
CITY 6 W ordinances and state laws relating to building construction,and hereby
(/�(��" ZIP of sale.)
CLASS/LICENSE N0. PHONE _ authorize representatives of this county to enter upon the above.
CLEARED FOR ISSUANCE BY DATE ❑ i,as owner of the property,am exclusively contracting with mentions roperty for paG Ion purposes.
❑ ROAD IMPROVEMENTS licensed contractors to construct the project(Sec.7044, d .��1
CONTRACTOR Business and Professions Code:The Contractors License Law
❑ DWY APPR. does not apply to an owner of property who builds or Improves anature of Acolicant or sent Date
MAILING ADDRESS thereon,and who contracts for such projects with a contractor(s)
❑ OTHERS licensed pursuant to the Contractors License Law.) HAZARDOUS MATERIALS
(FOR NON-RESIDENTIAL ONLY)
❑ INSPECTION REQUIRED P [OR TO FINAL INSPECTION. ❑ I am exempt under Sec. Indicate II the Intended occupancy will use hazardous materials.
CITY ZIP Initialing Yes acknowledges that H&S Code Sections 25505,26633,and
CLASS/LICENSE N0. PHONE ADS&AIRPORTS 25634 as well as filing directions were made available to you.
TITRACT APN � Owner dS_To('rPIS Date b� ❑ Yes
35 1
1a Vq CLEAREDFORISSUANC Y: DATE ❑ No
PLAN CHECK NO. PLAN CHECKER CODE YEAR
❑ RD Ih1PROVEMENT WORKERS'COMPENSATION DECLARATION
CASHIER'S VALIDATIONS
I hereby affirm under penally of perjury one of the following
TYPE OF IMPROVEMENT: REROOF ❑ DWY APPR' declarations:
Inr,,;
❑ INSPECTION RE UIRED PRIOR TO FINAL INSPECTION. D I have and will maintain a certificate of consent to self-insure for uu iuJ ui' �..,r r r r i.iUirr ivyu. • - n
BUILD ADDITION ALTERATION REPAIR MOVE CONVERT DEMOLISH workers'compensation,as providedfor by Section 3700ofthe
AREA STORIES DWELLING UNITS - Labor Coda,for the performance of the work for which this
ENVIRONMENTAL HEALTH -.-.._. unnJznnnnnn. nntnn...
permit is Issued.
PERMITNO. OCCUPANCY I TYPE OF CONSTRUCTION D l have and will maintain workers'cdmpensatlon Insurance,as -a;t "r r�C" 4uL L'Fi" .. 22
CLEARED FOR DANCE BY DATE required by Section 3700 of the Labor Code,for the performancer.� r`.__
JOB DESCRIP,�ON�D _ `�u\ h JC � 3 i h_. D HAZARD S MATERIALS compensatlonof the work rwhichInsurance cartIs Issued.My and policy number are:
\TTII ❑ WATER 1 YSTEM PERMIT# Carrier
D cy Number.
SEPTI SYSTEM PERMIT# Poli
(This section need not by completed If the permit Is for one
❑ INSP TION REQUIRED PRIOR TO FINAL INSPECTION. hundred dollars($100)or less)
... I certify that In the performance of the work for which this permit t+�nt �
FIREMARSHAL Is Issued,I shall not employ any person In any manner so as to c 'fli-!�'`vi•uJrii�"'�u1'�i�/�{' "
Ll become subject to the workers'compensation laws of California, •- """}'
COUNTY FILE NO. � �a^ and agree that If I should become subject to the workers' W Y 4µ
Gcompensation provisions of Section 3700 of the Labor Code,I
CLEAR FOR ISSUANCE BY DATE
shall felt comply with those provisions.
500 SCALE MAP N ❑ INSPECTION.REQUIRED PRIOR TO FINAL INSPECTION. "'""`°""'^ '['Ii'fy2�j/j,r7t1'f lyj j y yy w±'•
t� ��15�? � C>J_ t om{ CHEM,_ '
SPECIALINSTRUCTIONS plicanDale "�""'-"" CMI'"
VALUATION ......",.._••..._,...,.. . .. .., .
FEES WARNING:FAILURE TO SECUREWORKERS'COMPENSATION -
PLANNING 5--), S.M.I.P COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO
FIRE MARSHA SEPTIC CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF
PLAN CHECK PERMIT /00 _ COMPENSATION,DAMAGES AS PROVIDED FOR THE SECTION 3706
OTHER_ giimmmpk--- OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.- -
- -
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