13395 POST NEAR FRONT OF BUILDING:"
PFRMILNUMBER
s. CITY OF �CUPERTINO.
INSPECTION DIVISION 13395
JOB INSPECTION RECORD
• PERMIT EXPIRATION
11158 SUTHERLAND -*AVE JI
JOB ADDRESS IT# - LOT# ^ PERMIT EXPIRES IF WORK'
OWNER MARION HANSEN " CONTRACT, RRIL HANSEN 'IS'NOT;STARTED WITHIN
" INSPECTION DATE INSPECTOR INSPEC 'laO DAYS'OFPERMIT ISSU
' FOUNDATION ANCE-OR i SO DAYS FROM
-LAST CALL E 6INSPECTION.
PREGUNITE PERMIT VALIDATION .,
i' "•v„ -P - -
POUR NO C-ONCRETE UNTIL ABOVE HAS BEEN SIGNED — - ,Y. Ot/ • roti *• --- ✓
UNDERGROUND./SLAB O
PLUMBING.
ELECTRICAL. - .ISSUANCE DATE
.. MECHANICAL - 'l' - .i, • RLDG. •ELECT: MECH
PLG. - .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - - - 13UILDING PERMIT
WOOD FLOORINFORMATION .,
PLUMBING. ; n
VA CUAo N,' $/FT.
MECHANICAL .. - - -
PENIT TO
ELECTRICAL N(",
FRAMING -
STORIE �.yP STR.
INSULATION
{.
OCC,.GROUP 'RES.UNITS`
., PLACE NO SUBFLOOR UNTIL ABOVE-HAS BEEN SIGNED
4 " ROOF • 50 FL PLOOH AREA TOTAL,.ACREAGE
I
` DIAPHRAGM ` , •�
BU ILDING USE
'4j• RES IND- CON PB 0"",
El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED " • El" ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING �- "-� r J. r ,
GAS TEST. ' - •'•"', ___ _ - -E-�"` TRACTNo, PARCEL No,
MECHANICAL - ` �—��'�• ^id'" -
ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC,FILE.NO.
FRAMING • - SAN** zoNING ENc,srtE No.
INSULATION PLUMBING "'.�-
GAS Aa. -
FIRESPRINK ENERGY T.24
MECHANICAL - _
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' r (]'' NO' N�
..+
LATH—,INTERIOR ELECTRICAL ' FiooD zoNE. A.L.u.c.
LATH—EXTERIOR - FIRE DEPT. •,. Y•� "� Y "�•
SHEETROCK ' GRADE - FEESUMMARY
• SHEAR INTERIOR ' BUILDING . • ' BUILDING 17i `
SHEAR EXTERIOR TEMPORARY APPROVALS
- FIREWALLS-, - � � n ELECTRIC'', PLAN CHECK•''��' ,` ' FEE
• . - GAS -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE J
OCCUPANCY OF BU I LDING IS NOT PERMITTED'UNTI L BU I LDING F INAL IS SI GN ED BY BUI LO I NG INSPECTOR., MICROFILM.•'.
., u iA •' - -
ARRANGE FOR INSPECTION BY PHONING 252-4505; , ' ELECTRIC
F� „ ONE WORKING DAY. ,BEFORE REQUIRED INSPECTION } ' PLUMBING,
P) z ADDRESS WHEN PHONING. 11
p ✓ Z PLEASE GIVE JOB— SEE P.ERMIT• FOR EXPIRATION-DATE — MECHANICAL
CONST.TAX
IMPORTANT! ° W ,'•..
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
n ADESS APPLICATION & PERMIT ' 3395
ly noDRoness ^
I BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
a.NrOWNERS PLAN CHECK VALIDATION
NAME _ +'OTY. ELECTRIC PERMIT , FEE .
e
HONE
CO TKAGILHE
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
{�✓�`/ LIc.NO. ,/• LIGHTING FIXTURES " 10.00/1.00
CNA
DDCTOR's
ARESAPPLIANCES-RESIDENTIAL '4.00 '
6,-sI a6ar
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200.AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR Ao
ENGINEER '
• uc.NO SIGNS TRANS. 3.00
ADR H.ORDRESS ENG. SPECIAL CIRCUIT 5.00 'PERMIT VALIDATION
nP
EMP.METER OR POLE INS. 20.00
APPLICANTS - •MOTORS SEE FEE SCH. ))
ADDRESS ., 1 Qp�I•tra./\/
SERVICECHANGE - 20.00 �J -
LICENSED CONTRACTORS DECLARATION 5171 V
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCEDATE
y z a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w i" Professions Code,and my license is in full force and effect ❑rbl
❑ ❑
z o w - License Class Lic.Number
4 z w Date Contractor '
m s BUILDING PERMIT
wa _ OWNCR-BUILDER DECLARATION INFORMATION
AOR. LI MISC.- REFER TO ORD
a, g ,� N I hereby affirm that 1,m exempt from the Contractor's License VALUATION - $/FT.
FUOJ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Cade:Any city or county which requires a perinit to construct,alter, ELEC.CONTR. LIC. \v v
ce au¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.
as
6 c u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w m he is licensed pursuant to the provisions'of the Contractor's License /J
Law(Chapter 9(commencingwith Section 7000)ofDivision3 ofthe - _ �
�N
4 D Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
mI- m• the basis for the alleged exemption.Any violation of5eclion 7031.5 STORIEyS,G TYPE apNSTR.
i ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ``
of not more than five hundred dollars(S500T)
❑ I,as owner of the property,'or my employees with wages as BACK FLOW PROTECT, DEVICE 4.00 --UCC.OROUP 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
property who builds or improves thereon,and who dues such work FIXTURES-;PER TRAP 5.00 - SO.FT.FLOOR AREA TOTAL ACREAGE
! � himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.IL however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
t builderwill have thcburden of proving that he did not build or int- GAS-EA.SYSTEM-,OVER 4'(EA.) 2.00 BUILDWG USE:
prove for PuRox of sale.). - 1 INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB "Diner
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to c0nst alt lire project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Corumclor's License'Lasv does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
r contracts for such projects with u contractors)licensed pursuant to SEW ER'SANITAR V-STORM EA.200ft110.00
the Contr'actor's License Law. TRACT N0: PARCEL.NO.
❑ I em exempt under Sec. .B.&I'.C.for this WATER HEATER W/VENT- '6.00
mason - �
Owners 7��jhIJly' -- - WATER SYSTEM .- 5.00 ACC.DATE ACC.FILE N0,
W'ORKERS'COMPENSATION DECIARpTION WATER TREATING EQUIP. 5.00
II'h,mhy affirm that 1 have a certificate of consent to�sel Ginsure, ,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thercof(Sec.3800,Lab.C.).
Policy No. Company ,
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T"24
Z Z ❑ Certified copy is filed with Ore city inspection division. MISC.- REFER TO ORD.E .
p Applicant Y ❑ N❑ V ❑ N❑
CC y t PERMIT ISSUANCE 1000 FLOOD ZONE A.L.U.C.
LU CERTII7CCOI IT EXEMPTION PROM WOR KIiRS'
CL - COMPENSA'T'ION INSURANCE ;, PLG.CONTR. _ LIC.No. PLO. _
CL Z (This section need not be completed if the permit Is for one TOTAL Y❑ N❑ V❑ N❑
_ hundred dollar,($100)or less.)
U .
1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LLF ant is issued,I shall Hot employ any person in any manner so ns to
U mbjpe becoe suect to the Workers'Com nsation Laws of Californi
O a..
UJ
! �Q (�
a Dote Applican 'BUILDING
t - ALTER OR ADD TO MECH. 5.00
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
♦- ? emplion,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK / S�
provisions of lire Labor Code, you Most forthwith comply with FEE fP
U such provisions of this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 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 forwhlch this permit Is Issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT ITO 100,000 B.T.U.) 8.00
Lender's Name
Lenders Address HEATING UNIT(OVER 100,000B.T.U.0.50 ELECTRIC
I certify that I have read this application and stale That the above VENTILATION FAN (SINGLE) 4.00
in formation is correct.I agree to comply with all city and county PLUMBING
• ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.)'6.00
4 hereby authorize representatives of this city to enter upon the BOILER-COMP'(Over.100,000BTUl SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.'
(We) agree to save, indemnify and keep Ilurmless 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
granting of spermit, MECH.CONT. LIG NO. MECH. '
_ TOTAL TOTAL _
S /�
natr of pplicant/Con tor- Date /
OFFICE COPY _ - /