13053 (2) POST THIS Cob NEAR FRONT OF BUILDING •
" PmM(r NUMBER, _
CITY OF CUPERTINO 13053
INSPECTION DIVISION
JOB INSPECTION RECORD %?
•' PERMIT EXPIRATION', -
JOB ADDRESS 10120 Lockwood Drive UNIT# LOT# ' PERMIT EXPIRES IF WORK
OWNER William J. & Katherine. D. AlIT CTOR qplf IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 1160 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED INSPECTION.
LIFER
PREGUNITE vERnur VALIDATION - }
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I "'
UNDERGROUND /SLAB - P;JD
PLUMBING - - `' Qpn�S 1�/�//lr
ELECTRICAL jull�1 -1987ISSUANCE DATE
.BLDG. ELECT. PLG. MECK
MECHANICAL '
Ei of Curti 0 ❑ ❑ . .
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
�� PERMIT
ELECTRICAL � �, /I�'1lJ dDE
FRAMING _ - -
STORIES TYPE CONSTR.
INSULATION -
OCC.GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM.
BUILDING USE
' - RES IND 'CON PB Otlun
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - El ❑ ❑ ❑. ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL
.
ELECTRICAL - D-�j ACCDATE ACC.FILE NO.
FINALS DATE INSP. � .-
FRAMING 6 - 0-`6 SAN # zoNlNc ENG.SITE No.
INSULATION PLUMBING
GAS
- FIRE SPRINK ENERGY T 24
MECHANICAL Y [:] NO Y F] NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '
"FLOOD ZONE A.L.U.C.
LATH-INTERIOR - ELECTRICAL V '
LATH-EXTERIOR . FIRE DEPT. v[:]. NF] Yo NE]
SHEETROCK , _ _ GRADE FEE SUMMARY
SHEAR INTERIOR - - BUILDING R4 BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS' -y
FIREWALLS - ELECTRIC PLAN CHECK
FEE .v...-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. • MICROFILM
ARRANGE FOR-INSPECTION BY PHONING 252-4505, ELECTRIC
i
LU WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - MECHANICAL
- SEE PERMIT FOR EXPIRATION•DATE -
IMPORTANT! CONST.TAX'
PLEASE READ REVERSE SIDE BEFORE TOTAL '
CALLING FOR FINAL INSPECTION. J
OFFICE.COPY
APPLICANT TO FILL IN INFO ATION WITHIN RED LINES - USE RA' L POINT PEN ONLY
r BU I LDING PROJECT I DENTIFICAT PERMIT NUMBER
BUILDING APPLICATION & PERTT
ADsvla'O (j O(1WLC^ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13053
OWNER'S 11 r / 70
-PLAN CHECK VALIDATION
NAME n{ f•�� QTY. ELECTRIC PERMIT FEE
i
J4,vila'a
1�
HONE - �3
CONTRACTOR S
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 /u
Se LIC,NO. LIGHTING FIXTURES 10,00/1.00 16 -
CONTRACT 'sPPLIANCES-RESIDENTIAL 4.00
ADDRESS,
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ARC ESS erva- SPE CI ALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 PAID'
APPLICANT'S MOTORS SEE FEE SCH. �I {
ADDRESS 1
SERVICE CHANGE 20.00
Pao
wO o LICENSED CONTRACTORS DECLARATION city
a o U I hereby affirm that I am licensed under provisions of Chapter 9 n0 city
DATE
(commencing with Section 7000)of Division 3 of the Business and , w BLDG. ELECT. PLG. MECH.
F �D z Professions Code,and my license is in full force and effect.
Z 0 m - License ClassLic.Number ®_ ❑ ❑
9 w t w Date ContractorCn ertino
¢ y Cl Of p BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION
o A O REFER TO ORD
E:
I- I hereby all'inn that I um exempt from the Contractor's License MISC.-
u o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 _ u vAAL-uaTI-ON $/FT.
m ✓+ Code:Any city or county which requires.permit to Construct,al¢q 9WL 1f-T/1�,
pp Q Q Improve,demolish,Or repair ally 6lfnclurc,prior to Its Issuance,also ELEG CONTR. LIC.NO. ELE' /� iti /vim/l/
D ¢
requires the applicant for such Permit to file a signed statement that TOTAL 3 0 PERMIT T
u w w he is licensed pursuant to the provisions or the Contractor s License /� ,,rl
H Z r
Law(Chapter 9(commmnciagwith Section 7000)of Division 3 ofthe `-/av�-�E- LF'/L,f�L _
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
E i 0
¢ H$
the basis for lire alleged exemption.Any violation or'Scction 7031.5 STORIES TYPE CONSTR. I
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(S500).):
❑ 1,as owner of the property,or my employees with,w.gcS as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their solo compensation,will do lire 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 docs such work F IXTUR ES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentse not intended or offered for sale.IL however,the building GAS-EA.SVSTEM-l 6.00
a
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-
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00
❑ 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 not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEAJ 1.00
contracts for such projects with a con(raetOn S)licensed pursuunt to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractors License Law.
all lame empt under S .BAP.C.for this WATER HEATER W/VENT 6.00
lease
Ow Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION UECLARATI011' WATER TREATING EQUIP. 5.00
1 hereby Gill,., that I have a Certificate ofconsent to self-inone. 20rvIrvG ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified _
copy lhereuf(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK- ENERGY T 24
Z Z ❑ Certified copy is fled with the city inspection division. MISC- - REFER TO ORD.
0 Applicant - Y❑ N❑ Y ❑ N❑
ir m CERTIFICA'1'17 OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c.
W > COMPENSATION INSURANCE PLG.CONTR. LIF NO. PLG. Y❑ NE] Y ❑ NE]iL 0 (This section need or be completed if the Pennit,is for one TOTAL
::) Z hundred dollars IS 100)nr ILa.I
0 O 1 certify that in lire Polio nn:ucv al the work for which this per-'. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
{L F mit is issued,I shall not employ any Person in any Turner so as to
0 W become subject to the Workers'ComPc nsarion Laws ol'California.
Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /;;j .LI
} y NOTIC17 TO APPLICANTIf,afler making this Certificate of Ex-
Z_ emption,you should become subject to the Workers'Connpensarion APPLIANCE a 5.00 PLAN CHECK q
provisions of the Labor Code, you must forthwith cam Ply.with FEE /}�
U such provisions or this Permit shall be deemed revoked - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER IO)OODC.F.M.) 6.00 SEISMIC FEE
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.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC - 0
1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building-consvuctiom and BOILER-CDMPI3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this¢ity to enter upon the BOILER-COMP love,100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agreeto save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino a ainst liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may io a way accrue against said City in consequence of the
gr o .lh'Spermi{. MECN.CONT. LIC.NO. MECH.
a� TOTAL TOTAL 3
gn re ol'Applicant/Contractor Ua[e
OFFICE COPY