12997 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1299?
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 20956 Homestead UNIT# LOT
PERMIT EXPIRES IF WORK
OWNER Lynn DavisCONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
PREGUNITE
PERMIT VALIOATI ON
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ---
UNDERGROUND /SLAB �.
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH.
El u^ El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL -
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR,
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
SUILOING USE
RES IND CON PB Olw.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO. .
MECHANICAL
ELECTRICAL FINALS DATE INSP. ^cc.DATE - ACC.--FILE
FRAMING SAN #
INSULATION PLUMBING ,ZONING ENG.SITE NO.
GAS
• MECHANICAL FIRE SPRINK ENERGY T-20
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �:❑ N❑ ° ❑ N❑
LATH—INTERIOR ELECTRICAL fr FLOOD ZONE ,A.L.U.c-
LATH-EXTERIOR FIRE DEPT. v❑ N❑ 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 IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
® o� 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.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
-�iei` aooREss O� VAeS
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Zgg
OWNER a ' /!T7
NAME- -1 PLAN CHECK VALIDATION
d7i9 vi� QTY. ELECTRIC PERMIT FEE
nJ dJ s ��e . HDNE I Q
CON gCTOR'B
NgMuy C_(O OUTLETS-SWITCHES-RECEP 10.00/1.00
I, ,,,�, El(I es/y LIC.No. 3 6 LIGHTING FIXTURES 10.00/1.00
CNIRA TORS PPLIANCES-RESIDENTIAL 4.00 C
0 I(071 �t-p PHONE -37q-C PANELS 10.00 DATE OF APPLICATION Y
onCNITECi PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER 1
LIC,NO. SIGNS TRANS. 3.00
ADDDDRESS ENa. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 J�
APPLICANT'SMOTORS 'SEE FEE SCH.
ADDREDDRESSS
SERVICE CHANGE 20.00
002
0o LICENSED CONTRACTORS DECLARATIONID /� O
<U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w a vI (commencing with Section 7000)of Division 3 of the Business and I BLDG. ELECT. G. MECH.
r n Z Professions CodLand my license is in full fore and effect. J
Z 0 w License Class ',�9_Le.Number'LS 11'3[0 rVf
0 Z r w+l Date_ 5'-1 C-Sly Contractor
x Cupertino
¢_ ¢w a OWNER-BUILDER DECLARATION City �� BUILDING PERMIT
X ;LL N 1 hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
FuoJ Law for the following reason, 7031.5,Hasinessand Professions PERMIT ISSUANCE 10. 7- VALUATION
Code:Any city or county which requires permit reconstruct,alter,
2 ¢a 0 Improve,demolish.or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC,NO CLEC
u requires the applicant for such permit to file a signed statement that TOTAL 3 V
n w m he is licensed pursuant to the provisions of the Contractors PERMIT TO License �
H Z r
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i ae Business and Professions Code)or that he is exempt therefrom and
¢ I- $ the basis for the alleged exemption.Any violation of QTY. PLUMBING PERMIT FEE
Section 703 LS STORIES TYPE CONSTR.
ag_ by any applicant for a permit subjects the applicant ton civil penalty ' ALTER-DRAIN& VENT-WATER IEA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECTDEVICE 400
their sole compensation,will do the work,and the structure is not . .
OCC.GROUP RES.UNITS
intended or offered for sal,(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00
Code:The Contractors License Law dues not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.IL however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). ' RES IN CON PB Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 11 El 1:1 O ❑
licensed contractors to construct the project(Sce. 7044,Business LAWN SPRINKLERS- 1 INC 5 VB. 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 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 rlagcT NO. PARCEL No.
❑ I am exempt under Sec..,B&P,C,for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM _
5.00 ACQ DATE ACC.FILE NO.
WORK ERS'COM PENSATION D17CLARATION 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,ora certified ZONING ENG.SITE NO.
copy thereof(Sce,3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby fumis'hed.
Z Z� A Certifie py is fled witl, the city inspection division. FIRE SPRINK ENERGY T 24
F O Applicant �1 1 ,t � MISC.- REFER TO ORD. Y [] NE] Y ❑ NEI
CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.Lu.C.
Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL (This section need not be completed if the permit is for one TOTAL Y(] N❑ Y ❑ N❑
Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued.I shall not employ any person in any manner so as to
O Q become subject to the Workers'Compensation Laws of California.
n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} Do NOTICI7 TO APPLICANT: If,after making this Certificate of E.-
F.. Z emption,you should become subject to the Workeri 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 1Q000C.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,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -
Lemder'sAddress HEATING UNIT(OVER 100,000B.T.U.)9.50JELECTRIC 3v. �
I 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 PLUMBING
ordinanees end state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned property for inspection purposes. M ECH AN ICA L
(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
ImmDng of this ermif MECH.CONT. LIC.NO. MECH.
_ I�m _ - I �, R� TOTAL TOTAL
Signature of Applicant/Contractor
Date
OFFICE COPY