13326 ,a1
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13326
INSPECTION DIVISION ,
JOB.INSPECTION RECORD
PERMIT EXPIRATION
- JOB ADDRESS 22611 POPPY DRIVE UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER RICHARD GUZMAN CONTRACTOR'SAME'1' I IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .1BODAYS OFPERMIT ISSU-
FOUNDATION LANCE OR 180 DAYS FROM
UFER ALASTCALLED INSPECTION.
PREGUNITE J PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL �N' IsDAN DATE '6
I
MECHANICAL - G,I fLJ �`4�ll ll El PL❑c. ME.°
I
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING - f
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING L ..
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
` - SD.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM ROOF
BUILDING USE
RES IND CON PB O,he,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT N0PARCEL N0
. .
MECHANICAL �u �"""� o T1 ACC.DATE ACG FILE NO.
ELECTRICAL FINALS I DATE F INSP.
FRAMING SAN #
INSULATION - 4SIGNED
PLUMBING zGIVING ENG,SITE NO.
GAS
r �� FIRE SPRINK ENERGY TQ4
MECHANICAL Y ❑ N❑ Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEHEATING
LATH-INTERIOR � ELECTRICAL FLOOD ZONE A.L.U.C,
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE - FEESUMMARY
SHEAR INTERIOR I IBUILDING
SHEAR EXTERIORTEM
TEMPORARY APPROVALS BUILDING J
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 ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESSWHEN PHONING.
I` Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL _
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPV
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�} BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
EDILDING APPLICATION & PERMIT
ADDREssC�1 /f..L�.o�^t BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
1332,6
l` OWNER'5 PLAN CHECK VALIDATION
a" " i / ^7 QTY. ELECTRIC PERMIT FEE
`t (, PHONE / G- 2-
CONTRACTOR
V
CONTACTORS /NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 / /-"
5"_A.L.'L LIC.NO. 0 LIGHTING FIXTURES 10.00/1.00
foDIRFEE DE's APPLIANCES-RESIDENTIAL 4.00
0 W I PHONE �O PANELS 10.00 DATE OF APPLICATION
ORR HITECT sePANELS.(OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER n�k
LIC.No. SIGNS TRANS. 3,00 Ira1"i
ARCH.OR ENG, SOD PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
ZIP TEMP.METER OR POLE INS. 20.00 AUG 1 g 1987
APPLICANT'S
ADDREss MOTORS pnJIDE SCH.
SERVICE CHANGE 20.00 •L ru��rtigu
Q. XOLICENSED CONTRACTORS DECLARATIONI �6U /
rt u u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSU NCE DATE
H<w (commencing with Section 7000)Of Division 3 of the Business andBLDG. ELECT. PLG. MECH,
F N, Professions Cod nd my license is in full fore a i { QP. Ino
2D Date
lass Lim.Number 7 ,5- .... /dJ
O Z I- Date Contractor
a x s BUILDING PERMIT
¢ ¢ w at OWNER-BUILDER DECLARATION INFORMATION
w0 e m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H u 0 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 /O VALUATION S/FT.
w i Code:Any city or county which requires a permit to construct,alter,
¢ a, ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. p
O ¢ requires the applicant for such permit to file a signed statement that TOTAL V PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
H i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r o the basis for the alleged exemption.Any violation of Section 703 L$ 1 TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 -�y�-
of not more than five hundred dollars(5500)I xl/�/
01,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 Dec.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-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
I properly who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 5G,FT.FLOOR AREA TOTAL ACREAGE
1 I 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-1 INC.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 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB ornar
❑ 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 improves thereon,and who LAWN SPRINKLERS-O ERI6d A.) 1.00
contrathe Contrfor actor's ts
aeon(rnc(orts)licensed pursuant to SEWER-SANITARY•STORM EA.$OOft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
D I am exempt Ander S c. .B.&P.C.for this WATER HEATER W SN� U tom' 6.00
reason
Owner ate WATER SYSTEM .00
ACC.DATE ACC.FILE N0.
WORKF.RS'COMPF.NSATIO DECLARATION WATER TREATING E910 r 5.00
I hereby affirm that I 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.CJ. O d
Policy No. Company
0 ❑ Certified copy is hereby fnrRiShed.- FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division.
0 Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No
� y CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.0 d FLOODZONE A.L.U.C.
LU0 COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. ply_
CL C) (This section need not be completed if the permit is for one TOTAL Y E] N❑ V ❑ N❑
hundred dollars(S 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
TL F mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Com ensation Laws of California.
Q w Date-Applicant Applicant p so
Is. BUILDING ALTER OR ADD TO MECH. 5.00 1�Q
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex.
? emption,you should become subject to the Workers'Compensation APPLIANCE5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith Comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT( O,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVERiox6C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (VVI.T)P DIJCT) 5.00
the performance of the work for which this permit is issued f5ec. HEATING UNIT(TO 100,000' 1Ryl. 1 8.00 MICROFILM
3097,Civ.CJ.
Lender's Name HEATING UNIT(OV Fi T00,000 B.T.U.19.50 'j
Lender's Address ELECTRIC
I certify that I have read thisapplication and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county g01LER•CONfl 13 H.P.(31100,000 8.T.J 66.00 PLUMBING
. // ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 10GW0 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 10.001P-C- CONST.TAX
may in any way accrue a .ns t said City in consequence of thed
gra ngof isperon ` MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL ozv)
SS
Signature of"Applicant Contract Date "V o
OFFICE COPY
AV'I'I-Il_P>.id I iL.l . ILL )IV 11'J i=Lc.Fll:i-(f 1;)14 VVITI-IIIH Iii-.0 LII`:uf: - (J 1:It i�nE.L I'GIIV-1 PI-?V
-_ BUILDING PROJECT IDENTI FICATION I PERMIT NumaElt
BUILDING APPLICATION & PERMIT
BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 2
owN Ens r f / J'
• JJ^I / / ^7 / t� OTs. ELECTRIC PERMIT FEE ULAN CHECK VALIDATION
!1_1_/.L4EUC J C.11-C Z l•t4- /
JJ PHONE
•WNn1ACTURs UTLETS-SWITCHES-RECEP 10.00/1.00
NAM[
LIGHTING FIXTURES 10.00/1.00
'CONTHACTOn'S
t ADDRESS APPLIANCES-RESIDENTIAL 4.00
PANELS 10.88 I DATE OF APPLICATION
AH'Ini ECr I PLAN CHECK FEE P.C.NO,
ON PANELS (OVER 200 AMP) 20.00
EN61NEEP
LIG NO. _SIGNS TRANS, 3.00
p BpC«rlll Ervti.�Aunnes's SPECIAL CIRCUIT 5.00 PEIInIIT VALIDATION
n.• EMP.METER OR POLE INS. 20.00
jauuii[isrs MOTORS ';SEF,�FE E SCH. _ J
^� SERVICE CHANGE 20.00 fes(, /w•�'iIpgT?.IBO
�oo i LICENSI!D CON IRAC[OILS DECLARAT ION li •I 0� /1(O
a i w I hereby at'finn Thal I mu licensed under I,ro ..imu of Chap,'9 E(L.G_ n �1 /-1• .. i U�
a a fcomm,n,ing with Seelion 70001 of Uinown 3 W Ih1 Ruane,,and LG (1 ISSUANCE GATE
aLUQ ELECT. PLG. MECH.
Le,p,iola CoJc./IUJ my li:enu'is in Number lim�'vyl alb a. % f`:1✓__{ 1'lll l(;I�IiIU 1� ��
Z.o �L/'1 Licclu.•{la»SJ,3- _Lie.Nunlbel //C,.�yy'�/.S_ z �`
4 °, IDum-!_� _>`f7 Conua,nor LL✓IC4
¢ F BUILDING PERMIT
o A U
¢ ¢ w a OWNER-BUILDEROWNER-BUILDERIIECLAR,\'[ION
INFORMATION
w 3: r t I hereby alnico that I con exempt from Ili,Comnvlor',Licem,. MISC.- REFER TO ORD I
u O j Law for the following reason.(See.7071.5,bmineaand Prole„ioru _I VALUATION 5/FT.
m Code:Al cit or county which reuire>a PERMIT ISSUANCE 10.00 /J-
� Y Y Y 4 Penna Eneonsuance.also Q Q ¢ II11Prove,Jellluli,h,UI repair alp'flmt'lurc,prior ler its iaUOnlec,alio ELEC CONTII, LIC.NO. ELEC. a / 1 l
o¢ requires the applicant fur tach permit to file a signed>lalelnenl Ilan 'EOTAL ,J 'ter 1 PERMIT TO
m >, _m he i>licensed no,uant to the provisions DI tile Conlr:mtori Lia'n„
rzi Law(Cllxpur 9(culnmeneinuwith Section 7000)of Uivitiun Sof Ilia �1f
z o Ifutina>an,l I'r.1..l ns Codd or thw he i,cxempl tlmrellolu and QTY. PLUMBING PERMIT FEE /-
¢ F o Ilia basis lin the alleged exanpliall.Any viulutiun ul Section 7u 11.5 STORIES TYPE CONST I.
I = _ by any applicant,for a pernu,subjects the appiw,nl m..isapenall,
ALTER-DRAIN& VENT-WATER (EA") 5,00
ul nm-I'-"than 1111 hundred dollars($500).1:
0 I,a,owner of Ili, pmpa0y,or in,employee,wilIt ."c'a, BACK FLOW PROTECT. DEVICE '4.00 DCc.,ROUP RES.uNlis
their side cmnl,ensalion,will do the work,and the unlclun,n cul
intended or oUerL•d lar sale (Scc. 7044, Business and PD lc>,iom DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlruelur i Licen,c Law does not apply to an owner oI'
properly who builds or improves tlmreun,ad who Joessucll wmk FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AHEA TOTAL ACHEAGE
himself Or through his own employees,provided that such iolpruvo-
menu are not immnd,d or p114and l'm sale.Il,huwevcr,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or In,p Otn,u enl i,sold Willi,,one year of completion, the owner GAS EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden u1 proving that he did nil build ur 1111 - , ' ILDIINN Pa Col..USE
Prose to,purpose ul',ala.). INDUSTRIAL WASTE INTER. 30.00 RES IND N
1 0 I,s owner o1'tile property.am...Ii,ively cunvaclin,wishEl
licensed cDluactuo to crostruct the project(See. 7044,bu,ine'ss LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 I ASSESSORS PARCEL NO.
ad Prufessiwu Code:The C'ontractor's License Law dues not apply
to an owner of properly who build,or impruse,tllarcon,and wlnl LAWN SPRINKLERS-OYER 5( A.) 1.00 I
conlncls for such projects%Hit a cuntractuu,)licensed pursuant ler
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL NO.
❑ lam exempt under 5•. ,B.SIlC.fur lllit WATER HEATER WIVENT .''_ 6.00
reason I__�_
X
Owner ata WATER SYSTEM .00 ACC.UATE ACC FILE NO.
WORK Ii RS'CONI PI i NSATIO DECLARATION WATER TREATING EQUIP.' .'�' 5.00
1 lie,o by alliin than I bane v ccitificate'uf consent ler>elGin,anc.
or a cel nil irate of Workep'CUnlp,n,ution Luuau,,.err a,crtiti'd I I ZONING ENG.SITE NO.
copy)hereon(Sec.3hoo,Lab.C.l. '�/J J ' ,lie C717-
11
Policy Nu. Company
O I:) Ccrlil'i..d copy i,hcrcby famished. FIHE SPRINK ENERGY T 24
z Z 0 C..rtil'ied copy is tiled with the city impeclion division.
� 0 Appllclnl MISC.- REFER TO ORD. Yrs N[J Y ❑ N[D
CC9 CERAIPICA'N OF EXEMPTION I'RONI WORK hRS' PERMIT ISSUANCE 10.00 (� � --I FLOOD ZONE AL.U.C.
W > C•OMPENSAI'ION INSURANCE PI.G.CONTR, LIC,NO. PLO.
d O ('Phis seclion need nut be completM it' tile ..,null i, lar true TOTAL'1fa IN Y ElNEl y 11 El
� Z hund¢d A.11W,l$I UO)nI Is,,.)
U O 1 Candy stmt in Thr pert....Ban,,of the wmk I'or w1i81 Ilii,y1r DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL )- )nil is i,>Bcd,I shall con employ any person it r
any Iuanne ,o a,to
O w become .Ij,,t Its DI,Wolk,,,Cmuponmtiun Lows u1 Catowuda. -
n. Dan' Applicant ALTER OR ADD TO MECH. 5.00 I BUILDING
} y NO'I'ICIi"fU AI'I'LIG\N'1': II',aILL•r m.lking[]ItsCerl il'Ica(e..I lis
� Z anplion,you,hould be,00lc subject to the Wurk,,s Compcum Tun APPLIANCE5.00 PLAN CHECK
pruvi,iuns of the labor Code, you mast forthwith comply witll FEE
U 11th pmvisi..rn to win permit shall be dmm..d revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVERd0000C.F.M.) 6.00 SEISMIC FEE ✓ f^
1 hereby alliin that there is a eoo1,m,tiun bending agency Ill, EXHAUST HOOD WITH DUCT) 5.00
the p,rlimnuuce of the work lot which this permit is issued IS,,. I MICROFILM
3097,Gv.C.). HEATING UNIT(TO 100000,8.TU:1\' B.00
Lend,ri Nan,.. HEATING UNIT(OVER'100,000 B.T.U.)9,50 3 ' ✓v
Lender',Address I ELECTRIC
I certify that I have read this application and state than the abuse VENTILATION FAN (SINGLE) 4.00
inlmmat Tun is CUn,'d I GJ I=U
agar m g to building with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 I PLUMBING
unlinun,l, and ,Talc law, nclxllog In itycon,ter upon and
Lb.,, aull....ed• .....rity in,ins of on city to cora. upon due BOILER-COMP )Over 100,000 BTU)SEE FEE SCH. MECHANICAL
I abuvrinentiuncJ Properly aur inspection pugm,c,. f .
I (We) agree to save, indemnify and keep harmless the City of MISC.- F= REFER TO ORD.
Cup,nino against liabilities,judgnrenu, cuss, and expenses which PERMIT ISSUANCE 10.00 --. CONST.TAX
may in any way acerae Inst said City im m�tcq..cncc of Thu U
graWingfl
..f Kpermil '
) 1 / M[CII.CONT. LIC.NO. 10I:A _
l'UI nL ) '�
.Ci_t•S�L1'___-1_� ,,, L.c_y,:.- rS? �.5 TOTAL
_.
tilgll:lllll,a ApIlI1,aII liL.nlllra,IJ.• UJIe I -