12037 POST THIS CARD NEAR FRONT OF BUILDING
.� PF RM IT NUMBER
CITY OF CUPERTINO 12037
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10431 Prune Tree Lane UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER David Fantus CONTRACTOR Atlas Heating 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
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING '
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG. ELECT. PLG. M H.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - - VALUATION $/FT.
PLUMBING
MECHANICAL -
'PERMIT TO
ELECTRICAL �
FRAMING
STORIES .TYPE CONSTR,
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD.FT.FLOGR AREA iDTAL ACREAGE
ROOF -
DIAPHRAGM
�BUIDO USE
IN
' ,• RES O CON
PB Olnnr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ - ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - - TRACT NO. PARCEL NO.
MECHANICAL
ACC.OATE ACF FILE NO
ELECTRICAL FINALS DATE INSP.
FRAMING SAN *
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL
FIRE SPRINK ENERGY T ZA
.b
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y C] NE] v C] NE]
FLOOD ZONE A.L.U.C,
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT. Y E] N� Y ❑ N�
SHEETROCK GRADE l_-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 ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM
- w ARRANGE FOR INSPECTION BY PHONING 252-4505A' :,
ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED INSPECTIPLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! coNST.rnx
PLEASE READ REVERSESIDE BEFORETOTAL'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY L/
BU LD1 NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING
APPLICATION & PERMIT 0
'ADDRESS 10431 Prune Tree Lane BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
. NAME OTY. ELECTRIC PERMIT FEE
David Fantus PHONE 996-3513
cioR's
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Atlas Heating LID.NO, 46 266 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
ADDRESS TRAC APPLIANCES-RESIDENTIAL 4.00
155 Commercial St. PHONE 739-0516 PANELS 10,00 DATE OF APPLICATION
ARCHITECTPLANCHECK E .C.NO.
OR 9 PANELS (OVER 200 AMP) 20.00
ENGINEER ��
LIC.No. ISIGNS TRANS. 3.00
ARCH.OR ENG. P6R T Vg LIDATION
ADDRESS SPECIALCIRCUIT 5.00 MI
ZIP EMP.METER OR POLE INS. 20.00 y��APPLICANTS MOTORS MOTORS SEE FEE SCH. `l Of
ADDRESS
SERVICE CHANGE 20.00
D o O LICENSED CONTRACTORS D17CLARATION
< .u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
H c "' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MCN
r n z Professions Cod an license is in full for n
A.
Z D Lx License la Lie.Number ❑ ❑ ❑
N F w Date I r y Contractor
sa
m s BUILDING PERMIT
sa Q w a OWNER-BUILDER DECLARATION INFORMATION
X 3 DMISC.- REFER TO ORD
e y 1 hereby affirm that I am exempt from the Contractor's License
u0a Law forthe following reason,(See.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
� - Code:Any city orcounty which requires a Perm i ttocons(ruct,alter,
2Sa�D
improve, or repair any structure,prior to its issuance,also ELEO.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit ns file a signed actor's i (hat
nse TOTAL /[_�ivPp ntlT Tn .
w m he is licensed pursuant to the provisions of the Contractor's License
Hz> Law(Chapter 9(commencing with Section 7000)of0ivislan 3 of the
3 4 o Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
2I- fire basis for the alleged exemption,Any violation of Section7031.5 STORIES TYPE CONSTR.
u ; _ by any applicant for a permit subjects lire applicant ton civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is net
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
properly 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-
mentsarenotinlendedorofferedforsale,If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00
or improvement is sold within one year of completion, (lie owner- GAS-EASYSTEM-OVER 4 (EA.) 200
builder will have the burden of proving that h . . .
e did not build or im- BUILDING USE
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 NO CON PB Owar
❑ I,as owner of the property,an exclusively contracting with ES ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ,6.00 ASSESSORS FARCE L 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
contractsl such projects with a contractors)licensed pursuato 00tt/10.00
the Contractor's License Law. N SEWER-SANITARY-STORM EA.2
TRACT NO. PARCEL NO.
❑ I am exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORK F:RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I hove a certificate of consent Io SCINFoLue' ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
Copy the gr Sye 3100,Lab.C.). Allied Pae.
Policy N Company
Q Certilied copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 Certified�cpBy is fir wt'Ilk the city inspection division.
O ApPlicant___A .as_11Ba�n TTg MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
~ InPERMIT ISSUANCE 10,00 FLOOOZONE A.L.U.C.
Lu
CERTIFICATE E SAPIO'1'INS FROM WORKERS'
W � COMPIiNSAT'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL CL 0 (This section Held mat be completed if the permit is for one TOTAL Y F] N F] Y❑ N❑
hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY
11. U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Conhpensut ion Laws of California.
i Date Applicant ALTER OR ADD TO MECH, 5.00 rFEE
} to NOTICI7 TO APPLICANT': If,after making this Certificate of lix-
? emption,you should become subject to the Workeri Compensation APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with such provisionsor thispermit shallbe deemed revoked. AIR HANDLING UNIT(TO 1QOWCF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11F.M.) 6.00 I hereby affirm that there is a construction lending agency Ior EXHAUST HOOD(WITH DUCT) 5.00
lire performance of the work for which this permit is issued(Sec. 8.03097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 ULender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
i ntbrmition is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating t0 building constrixtion, and BOILER-COMP(3H.P.o1100,000B.T.U.1 6.00
hereby authorize representatives of (his city to enter upon the
above mentioned property for inspection purposes. BOILER-COMP (0,,.r 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which d CONST.TAX
may in any way acerae ugainsid City in consequence of the PERMIT ISSUANCE 10.00
granting of th permit. \ MECH,CONT. LIC.NO. MECH.
Atlas Heating 465266 TOTAL $18.00
Signature of Appltca f/Contr~ Cn - )at
OFFICE COPY