13625 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13625
INSPECTION DIVISION
JOB.INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10260 TULA LANE UNIT# Lor#
PERMIT EXPIRES IF WORK
OWNER JAMES C. HOFFMAN CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANC. OR 180 DAYS FROM
LASTCALLED INSPECTION.:
UFER
-
PREGUNITE PERMIT VALIDATION
_
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
. az ..
PLUMBING
ELECTRICAL - ISSUANCE DATE
NLDG. ELECT. PLG. MECH.
MECHANICAL El El Ed 0,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
77=
PLUMBING '.
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING
- ST0 R I-ES TYPE CONSTR.
INSULATION '
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA-70TAL ACREAGE
�- DIAPHRAGM _
p BUILDING WE
HES IND CON PD Olney
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED I`'' ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST moi. M V° I RACi N0. PARCEL N0.
MECHANICAL // C- J/,/71f/i2
ACC.DATE ACC.FILE NO:
ELECTRICAL FINALS DATE INSP. '
FRAMING SAN # (, -31- ZONING
PLUMBING ENc.SITE NO
GAS
F IRE SPRINK ENERGY T,-24
MECHANICAL YO No Y ❑ N❑.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD 20NE A1UG.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR' - FIRE DEPT. YNE] Y0 N❑
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILCIING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR.EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY
,�PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 13625
ADDRESS BUILDING-TUL0. Lit C.0 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OwNER'9 PLAN CHECK VALIDATION
NAME OTY, ELECTRIC PERMIT FEE
J A-rVt E3 C, IBJ PHONE 1 16
CONTRACTORS UTLETS-SWITCHES
NAME -RECEP 10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
aoDREss
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
xIP TEMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00p-A f
0 0 o LICENSED CONTRACTORS DECLARATION U 0
a u u I hereby affum that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Nzw
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F oi Professions Code,and my license is in full force and effect. ❑ ❑ ❑
z o`vl - License Class Lic.Number
o z H D Datc Contractor
a
or
fBUILDING PERMIT
rt w OWNER-BUILDER DECLARATION INFORMATION
w ;LL , I hereby affirm that I am exempt from the Conlmctor's Licenx MISC.- REFER TO ORD
wo� law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
� - Code:Any city orcounly which requimsa permit toconslract,alter,
aor Q FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w Ae he is licensed pursuant to the provisions of the Contractor's License
rzi
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �Lf3G
a Business and Professions Code)or that he isexempt therefrom and OTV. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
T g: - 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 drill.,(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEV ICE es 114(00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOGR,ROOF,AREA,COND"' .00
Cade:1'he Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who dues such work FIXTURES-PER TRAP ,� n %5.00 o.; ,t sFT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsurenotimendedorofferedforsale.IC-however,the building GAS-EA.SYSTEM-1 INC.40UTdETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) &911 0010 BUILDING USE
builder it]have the burden of proving that he did not build or ice- RES IND CON PB Other
prove for purpose of sale.l. INDUSTRIAL WASTE INTER. .I ,V�3D00
O 1,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 at property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a cootrxetons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. O TRACT NO. PARCEL NO.
❑ lam exempt under Sea ,B.&P.C.for(hu
reason WATER HEATER W/VENT 6.00
-
x Owner P Dam WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
NKER 'COMP:N N DECLARATION WATER TREATING EQUIP, 5.00
1 herebyaffirm that I have a certificate of oonsent to self-insure, ZONING ENG.SITE NO.
or a certificate of workers'Compensation Insurance,or a certified
copy thercof(See.3800,Lub.C.L
Policy No. Company
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T-24
Z Z O Certified copy is Iilcd.with tire city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
CCN CER3IIFICA'1'E0FIi XI i MPTION FROM WORKERS' PERMIT ISSUANCE _ 10.00 d - FLOOD ZONE A.L.uc.
LLI > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. r�
CL O
(This section need nal be completed if the Permit is 1'or one TOTAL V E] N E] V C] N❑
Z hundred dollars S100)or less,)
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers''Compensation laws of California.
0 y Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of 8x-
(_ ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you most forthwith comply with FEE
U such provisions or 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
I hereby affirm that there u a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 3097 Performance of the work for which this permit is issued(Sec.. HEATING UNIT(TO 100,ODO B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's AddHEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
ress
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county BOILER-CONP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and State laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ex,rno,,whichPERMIT ISSUANCE 10.00 - CONST.TAX
may in any way accrue,against Said City in consequence of the
granting of this perinit. MECH.CONT. LIC.NO. MECH.
v&Alf:f? TOTAL TOTAL
ignatom at Applicant/Z" rector 'Dat' e I
OFFICE COPY