13242 POST THIS CARD NEAR FRONT OF BUILDING
•- PERl.tlf NUMBER
CITY 0 CUPERTINO 13242
-INSPECTION DIVISION
JOB INSPECTION RECORD
® PERMIT EXPIRATION
JOB ADDRESS 10451 TULA' LANE UNIT# - LOT#
PERMIT EXPIRES IF WORK
OWNER BURT SIMONOS' CONTRACTOR ELTON' S PLUMBING IS NOT STARTED WITHIN
INSPECTION 'DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
;« J
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED `
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL ISSUANCE DATE
eIOG. ELECT. PIG. MECH.
MECHANICAL -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $JFT.
' .PLUMBING
MECHANICAL
ELECTRICAL - PERMIT ro
FRAMING QQ r•• �r
$TORIES TYPE CONSTR.
INSULATION
9'
OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
• SO.FT.FLOOR AREA
TOTAL ACREAGE
ROOF
DIAPHRAGM BUILDING USE
• RES IND CON PR 00,ry
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - E ❑ El El 13
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL,
' -ACG DATE PCC.FILE N0.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS
FIRE$PRINK ENERGY T�]<
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - '' ❑ N❑ r ❑ N❑
FLOOD ZONE P.LU.C.
LATH-INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. .v N❑ .n �] rv❑
SHEETROCK GRADE F FEE SUMMARY
SHEAR INTERIOR .BUILDING
BUILDING
SHEAR EXTERIOR � TEMPORARY APPROVALS
FIREWALLS ELECTRIC - PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE 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.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 13242
AOOREss BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
0 1G. NC'
OWNER'( PLAN CHECK VALIDATION
OTV11 t:t . ELECTRIC PERMIT FEE
( I..� � vuorva
CONTRACTOR sQ UTLETS-SWITCHES-RECEP 10.00/1.00
N15uT (� D 1 & LICNO L1 SIGa 1 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S \ L PPLIANCES-RESIDENTIAL 4.00
Ml 9A ers
�a
41,J PHONE ",��/Q PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 2AMP) 20.00
OR 00 PLANC ECK FEE C.NO.
ENGINEER
uc.rvo. SIGNS TRANS. 3.00
AR CW OR ENG. SPECIAL CIRCUIT 5,00 PER MIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 J
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
C LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
Z w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
G o i
PDLriooalfeenssions Code.yl licenseis in full fo_r
a feel
Z O e�Lic.Number
G Conluclor ❑ ❑ O
a x BUILDING PERMIT
F o W OWNER-BUILDER DECLARATION INFORMATION
F
3 LL m T
I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F u o a Law for following reason.( Business and Professions
PERMIT ISSUANCE 10.00
Code:Any city orcosmy which requiresa peonit VALUATION t/f T.
to construct, Req
2 a Q p improve,Demolish,or repair any structure,prior to its issuance,also ELEC.DONTR. LIC.N0, ELEC.
O u requires the applicant for such permit to file a signed statement that _ TOTAL PERMIT TO
X he is licensed pursuant to the provisions of the Contractors License .�
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ING PERMIT FEE Z_ (r
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMB
at H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects theapplicant toa civil penalty ALTER-DRAIN IEA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
OCC.GROUP RES.UNITS
their sole copention,will do the work,and the structure is not
msa
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 SG.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
ments not intended oroffered for oyeesme.ILed that suhemproing GAS-EA.SVSTEM-11NC.40UTLETS 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. RES IND CON PB Other
prove for purpose of sale J. INDUSTRIAL WASTE 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 improvn thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contrectons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STOR .200ft/10.00 Q� TRACT NO. PARCEL NO.
CII am exempt under Sec. B.&P.C.for this WATER HEATER W 6.00
sawn
Owner Dale WATER SYSTEM 5.00 qCC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATIN ,1U A. 5.00
I hereby affirm that I have a certificate ofconaent to self-insure, �nQ ZONING ENG.SITE N0.
n or a certificate of Workers'Compensation Insurance.or a certifeJ it
copy Ther Sec.3900,Lab.C.'.R>•�L, Ue{
policy No .Company /
O ❑ Ce rtilic op lis hereby fumiehed. FIRE SPRINK ENERGY T.24
Z Z 'W Cahifsed` p�^'Is�lsiledpe ihy city Inspection division. MISC- REFER TO ORD.
0 Applicant S P 1� Y❑ N❑ Y ❑ N❑
KN CER1'IFICATEOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A1.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. I.G.P ,�rr...Yy.
CL (This section raced not be compklcd i!the permit is for one TOTAL O _j Y❑ N❑ V❑ N❑
Z) Z hundred doll.(S 100)or less.)
U 0 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEEPBUILDING
ARY
U_ - Tilt is issued,I shall not employ any person in any manner w as to
Ow become subject Tithe Workers'Compensation Laws of California.Oate Applicant ALTER OR ADD TO MECH. 5.00GUS NOTICE TO APPLICANT: If,after making thn Certificate of Ex-
emption,you should become subject To The WorkeriCompensation APPLIANCE 5.00 provisions of the Labor Code, you must forthwith Comply with 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 10AOOCF.M.) 6.00 1 hereby affirm that There is a construction lending agency for .EXHAUST HOOD(WITH DUCT) 5.00he performance of the work for which this permit is issued(Sec.3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) B.00Lenderi Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address
q I certify that I have read this application mil slate Thal the above VENTILATION FAN (SINGLE) 4.00 CJ'6
informmion is correct. I agree to Comply with all City and county PLUMBING 2,0
ordinances and stale laws relating to building construction, and BOILER-OCfaP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Oxer 100,DDO 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 CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
tmnli ofthispc 1. MECH.CONT. LIC.NO. MECH.
.S }c/ ISI€7 TOTAL TOTAL
Signature of Applicant/Contractor DD he
OFFICE COPY