12984 ;� POST THIS CARD NEAR FRONT OF BUILDING
rERoar NUMBER
CITY OF CUPERTINO 12984
INSPECTION DIVISION
JOB INSPECTION RECORD
�1 PERMIT.EXPIRATION
JOBADDRESS 19000 Homestead Road UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR Face Inc. IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 'ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
PREGUNITE
PERMIT VALIDATION
'
r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
' PLUMBING S047
ELECTRICAL
ISSUANCE DATE
MECHANICAL 7 BLDG. I ELECT. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
- •
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING - f7LE- GT
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
_ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•� ROOF SOFT.FLOORAREA TOTALACREAGE
DIAPHRAGM
RUIIDI USE
' HES IND CON
PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT N0. PARCELNO.
MECHANICAL `
ELECTRICAL ACC.DATE ACC.FILE NO.
?2•B7 FINALS DATE INSP.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ' HEATING Y ❑ N❑ Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
-11 Y
LATH—EXTERIOR FIRE DEPT. Y❑ NO Y.❑ No
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR 1BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /t• 3
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
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 IDENTIFICATION PERMIT NUMBER
x BUILDING APPLICATION & PERMIT
OQd �ryEffF� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 12984
OWNER'S PLAN CHECK VALIDATION
1 NAME r
i` SSP /�iIVS Qv� ,.LS,.-3.�/J DTV. ELECTRIC PERMIT FEE
vHONE 7
CONTRACTOR'S
-./ N� UT LETS-SWITCHES-RECEP 10.00/1.00 �Q
r(�',7wGr LIC.NO. (p-•G LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
0 /9O(/ votemi xi vHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
NGINEER
LIC.NO. SIGNSTRANS. 3.00
ADDRESS ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.MET LE INS. 20.00
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
'
SERVCIC 20.00 qJ
_02
o O LICENSED CONTRACTORS DECLARATION (� ]�l2.
rt u v I hereby affirm that I am licensed under provisions of Chapter 9 K v.9- 3 ISSUANCE DATE
h<w (commencing with Section 7000)of Division 3 of the Business and
H w i Professions C.d ons licenis in full for PLG. MECH.
d-e c.7
BLDG. ELECT.
Z O w - License 1 a �' Lse ic.Number IO �S
o m=J Di. Contractor
z a ¢ OWNER-BUILDER DECLA ATION BUILDING PERMIT
a O INFORMATION
X ; w H I hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD
ar 0 J Law forthe followingumson.(Sec.7031.5,Business and Professions PERMIT ISSUANCE O VALUATION S/FT.
Code:Any city or county which requires a permit to construct,alter, 10.00
re FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ,,}r.'
D, requires the applicant for such permit to file a signed statement that TOTAL �x1 -
u w w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H Z < Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
X r$ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
n ; _ by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).) ALTER-DRAINSt VENT-WATER (EA.) 5.00
❑ I,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 the structure is not OCC.GROUP RES.UNITS
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
• properly who builds or improves thereon,and who does Such work FIXTURES-PER TRAP 5,00 SQ FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the
owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
prove for purpose of saleJ. RES IND CON PB Other
Cl 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project(Sec.7044,BusinessASSESSORS PARCEL NO.
1-1 ❑ El ID 11and Professions Coda The Contractor's License Law does not apply LAWN SPRINKLERS- 1 INC5 V.B. 6.00
to
contracts
owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
acts fur such projects with a conhactorl sl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under See..,B.&PC.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company '
O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is filed with the city inspection division.
Applicant I MISC.- REFERTOORD. YE) N❑ Yo No
Lr CE RTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
PLO
LU C O (This section coed not be completed INSURANCEION (he permit is for one PLG.CONTR. LIC.NO. TOTAL Y 0 N Y [J No
U Z hundreA doll:us($low or less.)
V O I certify that in the performance of the work for which this per- OT,r MECHANICAL PERMIT FEE SUMMARY
LL U mit is issued,I shall not employ y pe sI in of y manner w as to FEE
becom• t e Workers' fly
sof California.
D. Datc�Applicum ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTIC TO PI (CANT: If, fter making his Certificate of Ex-
F Z eruption,you should becomes jeer to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.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,Cie.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 Qs��
• 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct.I agree to comply with all city and county BOILER-COMM H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and slate laws relating m building construction, and
hereby authorize representatives of this city to enter upon the
B'
ILER-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 CONST.TAX
may in any way accrue against said City in consequence Of the 10.00
gra g r is per til. MECH.CONT.- LIC.N0. MECH.
ii Cf- x�NC . /3 TOTAL TOTAL
ature Of Applicant/Contractor Dare
- OFFICE COPY