12383 (2) POST THIS NEAR FRONT OF BUILDING • PERMIT NUMREP
CITAF CUPERTINO 12383
2 INSPECTION DIVISION
JOB INSPECTION RECORD
pp -•� PEOAkIii lRATION
JOB ADDRESS�' ��3 D Fn dl UNIT# LOT60.00 paid
OOOO # x'PERMIT EXPIRES IF WORK
DINNER Gt6-Do D611,2 CONTRACTOR IS.NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYSOFPERMIT ISSU-
FOUNDATIONAWE OR 180 DAYS FROM
$- LASTCALL'ED INSPECTION.
LIFER
PREGUNITE I .PERMIT VALIDATION
POUR NO CONCRETE UNTIL A O IE HAS BEEW SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL.' ISSUANCE DATE
MECHANICAL Bk, ELECT. PP[E�GG. MEC
• � lXJ �•
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - - INFORMATION
VALUATION .$/FT.
PLUMBING - -
MECHANICAL 143.000',
ELECTRICAL PEHMIT TD
FRAMING Bin la Paini
INSULATION STORIES T41 Cyw
1
OCC.GROUP RES.UNITS
PLACE NO SUBFL06R UNTIL ABOVE HAS BEEN SIGNED R—$
• ROOF - SG.FT.FLCOH AREA TOTAL ACREAn[
DIAPHRAGM 2227
BUILDING USE
_ HES IND .CON PB Olney '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED [::�t ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL No.
PLUMBING Gr• 0,0- rHAcr No. PARCEL NO.
GAS TEST
MECHANICAL 7907
ACC,DATE ACG FILE NO.
ELECTRICAL FINALS DATE INSP.-
FRAMINGMOVE
SAN # (p•{•� zoNlNc ENG.SITE NO.
INSULATION PLUMBING
GAS �. �7INK ENERGY h2<
MECHANICAL $.,3-8CO ER NO ORK UEN SIGNED HEATING
❑ N ❑ No
LATH-INTERIOR . ELECTRICAL ,3 Y
441
A.L.u.c.
LATH-EXTERIOR I-3'8'7 >/J,� FIRE DEPT. - v❑ , " • Y ❑ No
SHEETROCK - GRADE I{y, E SUMMARY
SHEAR INTERIOR I BUILDING 1 401-3- -
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING 0
,50
FIREWALLS ELECTRICaPLAN CHECK
GAS ,'J, FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE. 10.01
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHO=252-i4505 ELECTRICoONE WORKING DAY BEFORE REQUIPLUM61NG
Z PLEASE GIVE JOB ADDRESS WHEN P— SEE PERMIT FOR EXPIRATIOMECHANICAL
IMPORTANTI
CONST.TAx
• r •
PLEASE READ REVERSE SIDE BEFORE TOTAL 824.41
CALLING FOR FINAL INSPECTION.
OFFICE COPY
`APP
LICANT TO FILL IN INFO 10 WITHIN RED LINES - USE B!•POINT PEN ONLY
r• 1 LDING PROJECT IDENT]FICATI - PERMIT NUMBER
'�IIOIL¢ APPLICATION & PERMIT
dEtisi
21130 Rainbow Dr. . / BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 1 238
OwA'^ CHECK VALIDATION
Y- TY.GR�GO$Y-GROUP ELECTRIC PERMIT FEE
j 351.33 ,
rNAMEHACTorF yp�+ �AOUTLETS-SWITCHES-RECEP 10.00/1.00 160.00 paid
sa�ri LIGHTING FIXTURES 10,00/1.00
CONTRACTOR v .cyy.� ,/r,J PPLIANCES-RESIDENTIAL 4.00
ADDRESS
_`(l VHONES%V i�/V• PANELS 10.00 DATE OF APPLICATION
ORCHITEC / �p ,t¢,Qe� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
H
ENGINEER
'.ao. SIGNS TRANS. 3.00
ARCH.OR ENG q PERMIT VALIDATION
ADDRESS � /f �/ / - SPECIAL CIRCUIT 5.00
EMP.METER OR POLE INS. 20.00 nn nXj •� (1 �Ojpl
AvvucANrs MOTORS SEE FEE SCH. 1'1,M1 1 (�
AooHEss . :/tel�+'� /1X �N n_
n /,I/� D� SERVICECHANGE 20.00 C's,Y X90/ G7
0 0 0 LICENSED CONTRACTORS DECLARATION /U
a z w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
P-o i Professions Code,a y license is in full forgepryl ffR�ejz ® ❑ ❑ ❑
z o L License Class Lic,Number-]Y 1aJ7G_ -
O m H Date Cotuncom
a m f BUILDING PERMIT
¢ ¢o ic o OWNER-BUILDER DECLARATION INFORMATION
X _u _ 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
O a Law for the following reason.(Sec,7031.5,Business and Professions VALUATION $/FT.
PERMIT ISSUANCE 10.00
0� Code:Any city or county whichregoiresupermlttoconstruct,niter, 143,000
Qtaimprove,demolish,or repair anystructure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
to
o LL requires the applicant for such permit to file a signed statement that TOTAL
A w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
F z <
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Single Family Dwell
E 4 o Business and Professions Cuda)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢t-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
dg •. by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).): 1 5 N. Hr.
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES,UNITS
intended or oR'cred for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 R-3 1
Code:The Contractor's License Lew does 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-
mentsarenutintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 2227
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA) 200
builder will have the burden of proving that he did not build nr int- - . . .
BUILDING USE.
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES� IND CDN PB Omer
❑ I,as owner of Lite property,am exclusively contracting with . OK El ❑ El ,
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 // y .�
to an owner of property who builds or improves thereon,:md who LAWN SPRINKLERS-OVER 5(EA.) 1.00 10 6-9- 31 3'1 a-3
contracts for such projects with a contractors)licensed pursuant to z
the Contractor's License Law. SEWER-SANITARY-STORM V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 7907
on
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
'NORKERS'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 Insuranre,or a cert ificd ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab C.). O
Policy No. Company &IV/
Cerlifie hereby furnished. FIRE SPRINK ENERGY T 24
Z Z Certi fid is fed with the citynspxmion division.
O plieant _A ky� ,¢_o eco MISC.- REFER TO ORD, Y EJ IN Y [] NE]
CC y CERTIFICATE 'IiXEMPFION FROM WORKERSPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
ION
NCE
CL O (This Section need not be compllNs'Rf lite permit is for one PLG.CONTR. LIC.NO. PLG
TOTAL Y N V N
::) Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued. I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
0- Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDI 5540,50
>_ to NOTICE TO APPLICANT': If,after making this Certificate of E
emotion,you should become subject In the Workers'Compensation APPLIANCE 5.00 PL HECK
Provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0DOQF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 1 EE 1'0.01
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
lite performance of the work for which this permit is issued(Sec. I V$$p
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9,50
Lender's Address ELECTRIC
0 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building,construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,Oo0BTU)SEE FEE SCH, MECHANICAL
.t above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
1 Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may ay accrue.against s "d City in consequence of the PERMIT ISSUANCE 10.00 273.90
ting Of this rmlt. MECH.CONT. LIC.NO. MECH.
_ �! ��er TOTAL TOTAL 824.41
Ignatu .1 Applieant/C.rI tor" Date
OFFICE COPY