13934 - 1
POST THIS CARD NEAR FRONT OF BUILDING
' PF RPfIf NUMBER
CITY OF CUPERTINO 13934
r J INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10325. TULA LANE UNIT# Lor#
PERMIT EXPIRES IF WORK
OWNER JACKYUAN CONTRACTOR IS NOT STARTED WITHIN
• INSPECTION - DATE INSP CTOR INSPECTION RECORD 180 DAYSOF PERMIT ISSU-
FOUNDATION P�,`_l 4417 ANCE OR 180 DAYS FROM
LASTCALLED.INSPECTION.
UFER
PERMIT VALIDATION j
' PR EGUNITE
t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CI, 11.�
UNDERGROUND /SLAB'
PLUMBING
ELECTRICAL I ISSUANCE DATE
MECHANICAL a11LL�DGELECT. PLG. MECH.
LJ� ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOORINFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL _„1/PERMIT ro -
FRAMING - •i " '
INSULATION STORIES/ TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED +
SO.FT.FLOOR AREP TOTAL ACREAGk
ROOF
DIAPHRAGM BUILDING USE
RES IND CON PB Otn"
El 0 El Cl
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED. El
ASSESSORSPARCEL NO.
ROUGH
PLUMBING _
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL,
ACC.DATE ACC.FILE NO.
ELECTRICAL - FINALS DATE INSP.
FRAMING SAN # zONING ENG.SITE NO.
INSULATION PLUMBING
GAS
_ FIRE SPRINK ENERGY TZ<
MECHANICAL v [:] N❑ v ❑ NE)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH—INTERIOR ELECTRICAL ELoop ZONE A.L.U.c.
LATH—EXTERIOR FIRE DEPT. I] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK 1 `
GAS
- FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE"
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ELECTRIC
Lu ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� 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. -�
OFFICECOPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
'r amisiiiiNO APPLICATION & PERMIT
ADDRu
l` UILDING -ELECTRICAL-PLUBING-MECHANICAL
13934
OWNER'$
PLAN CHECK VALIDATION
NAME L OTY. ELECTRIC PERMIT FEE
Fat�. /�, X141 PHONE O
c 's UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIGHTING FIXTURES 10.00/1.00
LIC,NO,
r-DNK TORS PPLIANCES-RESIDENTIAL 4.00
ADORES
PHONE 1PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMP) 20.00
ENGINEER
X. i LIC.No. SIGNS TRANS. 3.00 r�u
ARCH.OB D. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ADDRESS
.c ZIP TEMP.METER OR POLE INS. - 20.00
APPLICANTS MOTORS SEE FEE SCH. 1 s-oft^7
ADDRESS
�f
SERVICE CHANGE 20.00
O ,�t,, /O//^
0 O LICENSED CON]'RACfORS DIiCLARATION /�/J
< o u I hereby affirm that I am formed under provisions of Chapter 9 ISSUANCE D TE
s,a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
H n z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
License ClassLic.Number
9 H w Date Contractor
Number-
P: y s BUILDING PERMIT
¢ Q w OWNER-BUILDER DECLARATION INFORMATION
we m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
Hiro Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 1000 VALUATION 5/FT.
J
Code:Any city or county which requires a permit to construct,e)ler, oo Q
a rt< p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. ll��
- 0 1, requires the applicant for such permit to fik a signed statement that TOTAL P RMIT TO
w$y he is licensed pursuant to the provisions of the Contractor's License
F z Q Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe
4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
I- a the basis for the alleged exemption.Any violation of Section 7031.5 STORI TYPE CDNSTR.
a ; by any applicant for a permit subjects the appplicanttoamilpenally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500)J: '
❑ 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 the structure is not OCC.GROUP RES.UNITS
intended Or offered for sale (Sec. 7144, 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 holds or improves thereon,and who don such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00
mems arc not intended or offered for sale.If,however,the building
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[hal he did not build or ire- RES IND CON PB Oth.r
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with [1 ❑ 11 El F-1
licensed contactors 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 Low does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contacts for such projects with a contracmrts)licensed punuanl to SEWER-SAN EA.200ft/10.00 TRACT N0. PARCEL N0.
the Contactor',License Law.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner_ f 14 Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
W KERS' MP'N N DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers Compensation Insurance,or a certified
Copy thereof(See.3800.Lab.C.).
Policy No. Company '
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T 24
Z = ❑ Certified Copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y [:] N❑ Y ❑ N
❑
p: y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L,U.C.
LU CERTIFICATE EXEMPTION FROM WORKERS'
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) = hundred dollars(51DO)or lay.)
L) O I certify that in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- tit is issued,I shut] not employ any person in any manner w as to
U Come sir ec t IsF Workers'Com lion Laws f California.
O w DateApplinnt ALTER OR ADD TO MECH. 5.00 BUILDING
} NOTIC P L�/IICA T If,aft t ¢a f lix-
F 2 emplion,you should become subject to the WOr: 'Compensation APPLIANCE 5.00 PLAN CHEC
provisions of the Labor Code, you must forth ith Comply with FEE
(.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE IS Q
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 u issued(Sec. HEATING UNIT(TO 100,000 B.T.U.1 8.00 MICROFILM
3097,CN.C.).
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Icertify that l 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 county PLUMBING
ordinances and state laws relating to building construction, and BOILER-cow(3 H.P.Or 100,000 B.T.U.) 6.00
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 purposes.
(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 a y accrue against Sall City In comequence of the
SontIng0 "perm MECH.CONT. LIC.NO. MECH.
Y TOTAL TOTAL
y\
Signal a ppl' Dale
OFFICE PY