14211 '-` POST THIS CARD NEAR FRONT OF BUILDING'
.. PERMIT NUMBER
CITY ' OF CUPERTINO 1421
INSPECTION DIVISION
JOB INSPECTION RECORD
'. PERMIT EXPIRATION
JOB ADDRESS 10350 LANSDALE AVE UNIT# LOT#
' - PERMIT EXPIRES IF WORK
OWNER HERB & PAM YEARY ` •CONTRACTOR _ _ IS'NOT STARTED WITHIN
INSPECTION DATE TINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - - ..ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
' - '
PREGUNTE . PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ..of ?
UNDERGROUND /SLAB Q p' /
PLUMBING 9- 8ph l,
p
ELECTRICAL 4 ISSUANCE DATE
MECHANICAL BLDG, PLG, MIEcry:
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT
_ INFORMATION
WOOD FLOOR VALUATION $JET.
I PLUMBING.
MECHANICAL
ELECTRICAL PERAIIT TO-
FRAMING
1 INSULATION, - . STORIES TYPE CONSTR.
- - OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
I ROOF SQ IT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM - BUILDING USE
RES IND CON PB Other
•APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E 0 0 0
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL! ACC.DATE ACC.FILE NO.
.ELECTRICAL' FINALS DATE INSP. -
FRAMING ISAN a ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS -
FIRE SPRINK ENERGY T-74
' MECHANICAL Y [l NE v Q NE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD zorvE A.L.u.c.
LATH—INTERIOR I I ELECTRICAL-
_ LATH—EXTERIOR 'Z� - FIRE DEPT.
E v 0 NF] v NN[]SHEETROCK GRAD .' FEE SUMMARY
' SHEAR INTERIOR BUILDING — rs •
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS .
FIREWALLS, ELECTRIC PLAN CHECK
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -�
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ,
LU ARRANGE FOR.INSPECTION BY PHONING 252-4505ELECTRIC -
,
F ONE WORKING DAY BEFORE REQUIRED INSPECT!ON• PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL >✓
_
.— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL Vie'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.l BUILDING PROJECT IDENTI FICATION 1 � PERMITNUMBER
BUILDING APPLICATION & PERMIT A ^
0350 LvQNstjVt BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 42 I
OWNER'S'. PLAN CHECK VALIDATION
I �( NAME /� T QTY. ELECTRIC PERMIT FEE )(�9
Rf3 //�J Y16 /4 PHDNE V/.l - ISI _- /V
NAME CTOR's ZO: UTLETS-SWITCHES
-RECEP 10.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00 0 ' -
OONTHACTORS APPLIANCES-flESIDENT IAL 4.00
A DORESS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT IPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NIT
OR
ENGINEER
uc.rvo. SIGNS TRANS. 3.00
ARCH.OR ENO.
ADDRESS SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS '
SERVICE CHANGE 20.00 ! '1
w o o LICENSED CONTRACTORS DECLARATION
<u u I hereby affon that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H Q w (commencing with Section 7000)of Division 3 of the Business and B DG. ELECT. PLG. MECH.
F y z Professions Code,and my license is in full force and effect
z O m - License Class Lic.Number ROL Jim �-
Q y H w Date - Contractor
s, y f y3BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION ATION
w 3 LL r 1 hereby affirm that I.am exempt from the Contractor's License MISC.- REFER TO ORD
01
u04 Law for the following reason.(Sec.7031.5.Businessund Professions PERMIT ISSUANCE. 10.00 (� ITJ TION S/FT.
E - Code:Any city or county which requires permit to construct,alter, 3 3
re ¢ Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.rv0. ELEC. /
- O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
R
m he is licensed pursuant to the provisions of the Contractor's License
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the /��p/ %G•a'V
Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Eio
¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;'9 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER.(EA.) 5.00 '
of not more than five hundred dollars(S500)J:
_ ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and(be 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 Impnmce thereon,and who does SUCH workF.IXTUR ES-PER TRAP 5.00& - FLOOR AREA TOTAL ACREAGE
himself re of intended
his own employees,provided that such improve.
ments mselfe throuhh is onemployeesale.provided
that such
emprovg GAS-EA.SV$TEM-11NC.40UT1_ETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
proveforpurposeofsaleJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to cmostnot 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 properly who builds or improves fiction,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a coutraetodo licensed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt unde Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner_ Date WATER SYSTEM 5.00 ACC-DATE ACC.FILE NO,
W'ORKERS'COMEE ATE RATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure' ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.Cd. -
Policy No. Company
O 0 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.
0 APpliumt Y ❑ N❑ Y ❑ N❑
CC CERTI FICA TE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00A FLooO zorvE A.L.0 c.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section'need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
::) Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ H- mit is issued,1 shall not employ any person in any manner so as to
OW become subject fo the Workeri Compemution Laws of Califooia' BUILDING lr,fr0
a Date Applicant ALTER OR ADD TO MECH. 5.00 S Q fp
} y NOTICE TO APPLICANT: 11,after making this Certificate of E.-
attrition,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 er this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE o2 3
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. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name AEE
UNIT 100,0008. .U.19.50 ELECTRIC �o
Lender's Address
1 certify that I have read this application and state tl al the aboveN (SINGLE) 4.00
information is correct I agree to comply with all city and countyP.or 100,000 B.T.U.) 6.00 PLUMBING V -
orLinancus and stale laws relating to building ....(ruction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposesee .
(We) agrto save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may ry way accrue is MECH.against said City in conscyuence of the PERMIT ISSUANCE 10.00 '�
gr lin this pe - MECH.CONT. LIC.NO.
j_ TOTAL �S TOTAL oZSB�i
Si atureof Applicant/Contmc Dare O
OFFICE COPY