13514 !POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO 13514
'INSPECTION DIVISION
,. JOB INSPECTION RECORD
PERMIT.EXPI RATION
10324 ANN ARBOR AVE
• JOB ADDRESS UNIT# LOT#f
- PERMIT EXPIRES IF WORK
OWNER GLORIA 'DEAL cDNTEAcroR ` 'IS NOT STARTED WITHIN
INSPECTION. DATE 11NSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT ISSU- .
FOUNDATION - 0 ANCE OR 180:6AYS FROM ,
LIFER 'LAST CALLED INSPECTION.
'-
- _ •�
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB'
PLUMBING fFQ VI"" , 4 '
ELECTRICAL - - '
tr. ISSUANCE DATE'
MECHANICAL p>v� 'E�Ecr Puc. MECR:
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I ILDING PERMIT
WOOD FLOOR' - - INFORMATION
• PLUMBING A�unrioN s/FTr
MECHANICAL `/�.I
ELECTRICAL "PERMIT TO +
. - . FRAMING
INSULATION " - STORIES- TYPECONSTR.
Y
OCC.GROUP RES.UNITS`
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
�
ROOF , SO,FT'FLOOR AREA TOTAL ACREAGE
DIAPHRAGM., - BUILDING use
. .Res ,IND 'CON PB `omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1:1 0: El . El ❑
" ROUGH - ASSESSORS PARCEL NO.
PLUMBING - -
GAS TEST . , - TRACT NO ,P RCEItNO.
MECHANICAL ' - " 'v
ELECTRICAL `FINALS" DATE m INSP. ACC!DATE ACC FIG NO
FRAMING s ,JI. SAN 0 "
S ZONING END SITE NO.
INSULATION PLUMBING _ -
GAS "£
• MECHANICAL FIFESPRINK / ENERGYT24
"COVER NO`WORK UNTI LLABOVE HAS BEEN SIGNED- HEATING E] "� ❑ ❑
'LATH-INTERIOR ELECTRICAL ;, FLOOD"ZONE. . A.I.U.C..
LATH=EXTERIOR - - - FIRE'DEPT. ' Y❑ ' No ,Y ❑ No
SHEETROCK GRADE -
FEE SUMMARY
" P
SHEAR•INTERIOR - BUILDING W . - -
SHEAR EXTERIOR , TEMPO RARY.APPROVALS BUILDING A 'w?
FIREWALLS ' -" " ' ELECTRIC „ ` PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
OCCUPANCY OFBUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION-BY PHONING 252-4505, ELECTRIC
HONE,WORKING DAY BEFORE`REQUIRED,INSPECTIO]N. PLUMBING
z PLEASE GIVE•JOrB,ADDRESS WHEN PHONING.
=SEE PERMIT FOR EXPIRATION DATE - MECHANICAL*
CONST.TAX
IMPORTANT!.'
PLEASE READ REVERSE SIDE BEFORE TOTAL f
.CALLING FOR FINAL INSPECTION. ,
OFFICECOPY,
ADDITIONAL PERMIT FEES
BUILDING PROJECT I DENTI FICATION VALUATION
ADDRESS
Aoonss/� ANn. AR/Sv2 i4✓�� l�' � d
6W FEESUMMARV
O°MT"ACTOfl5 BUILDING
S ro0 TQO e TIC.NO ora 74173_ PLAN CHECK
CONTRACTORS Tons FEE
A �ZyG .c S *jt'2f SEISMIC FEE
.. 5'a
DTVELECTRIC PERMIT FEE
UTLETS-SWITCHES-RECEP TRIC
LIGHTING FIXTURES
PPLIANCES-RESIDENTIAL PLUMBING
PANELS \J MECHANIQA
SIGNS ` �ITI
SIGNS TRANS. O TOTAL 7
SPECIAL CIRCUIT
EMP.METER OR POLE INS. PERMIT VAUDATJON
MOTORS SEE FEE SCH. � SO
Q SERVICE CHANGE L �
1- q TOTAL ��,
y
ISSUANCE DNTE
W GN. PLUMBING PERMIT FEEELDc. EJECT. Pic. MECNCL ,
Z ALTER-DRAIN&VENT-WATER(EA.) ❑ ❑ 10
U O BACK FLOW PROTECT.DEVICE
LL 1—
O w DRAINS-FLOOR,ROOF,AREA,COND.
} d FIXTURES-PER TRAP
h
1- z GAS-EA.SYSTEM-I INC.40UTLETS
(„) GAS-EA.SYSTEM-OVER 4(EA.)
INDUSTRIAL WASTE INTER.
LAWN SPRINKLERS-1 INC 5 V.B.
LAWN SPRINKLERS-OVER 5 IEA.)
SEWER-SANITARY-STORM EA.200R/
WATER HEATER W/VENT
WATER SYSTEM
WATER TREATING EQUIP.
TOTAI
•,
CITY. MECHANICAL PERMIT FEE
ALTER OR ADD TO MEC H. �
APPLIANCE -
AIR HANDLING UNIT 1TO 10,000C.F.MJ
AIR HANDLING UNIT(OVER 10,000 C.F.M.)
EXHAUST HOOD(WITH DUCT)
HEATING UNIT(TO 100,000 B.T.U.)
HEATING UNIT IOVER 100,000 B.T.U.)
VENTILATION FAN(SINGLE)
BOILER COMP(3 H.P.or 100,000 B.T.U.1
BOILER COMP 10- 100,0008701 SEE FEE SCII.
TOTAL
"APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
ADILDING
'APPLICATION & PERMIT ,
Ao pF,� /. r Ze
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13514
.
Ow/rvERU'S PLAN CHECK VALIDATION
TY. ELECTRIC PERMIT FEE
Y �ZC vRONEJ/(�
MOMS acrORs UTLETS-SWITCHES-RECEP 10.00/1.00
LIC,No. LIGHTING FIXTURES- 10.00/1.00 .
ADDRESS
ORs - - APPLIANCES-RESIDENTIAL 4,00
CONTRACTORS
C
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE, P.C.NO.
ENGINEER
Lac.NO. SIGNS TRANS. 3.00
noo ESS ENG. SPECIALCIRCUIT 5,06 PERMIT VALIDATION
. ZIP ITEMP.METER OR POLE INS. '20.00 '-
APPDOArvr'sADDRESS A - MOTORS SEE FEE SCH. KJ
SERVICE CHANGE 20.00 /-
w'¢i /f'L/ �7
F02 LICENSED CONTRACTORS DECLARATION EEE/ /
a v u 1 hereby affirm that'I am licensed under provisions of Chapter 9 I5 DANCE GATE
w G N' (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H y z Professions Code,and my license is in full force and effect. r
z o w - License Class Lia Number
N
o � r�
Date.Contractor F - J
m s NGPERMIT a.
M ¢o i 0 _ OWNER-BUILDER DECLARATION x 1 RMATIO IT ` t
E:
R.LL r 'Thereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
S. 0 ¢• Law for the following reason.(Sec.7031.5,Busin¢Ssand Professions VALUATION $/FT.
m w E Code:An cit orcount which re PERMIT ISSUANCE 10.00 P.Jyf
Y Y Y requires permit to construct,alter,
ce R> O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
G u requires the applicant for such permit to file a signed statement that TOTAL �'] O
LT
o. w m he is licensed pursuant to the provisions of tire PER
e Contractor's License Of Capel NtSy'
z> Law(Chapter 9(commencing with Section 7000)of Division 3 of the < Cl/
E 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT a ., FEE C r6yrC, /�•'"J�'lr-G
w r$ the basis for the alleged exemption.Any violation of Section 703115 STORIES TYPE CONSTR.
n ;_ by Say applicant for a permit subjects the applicant to a civil penalty
of not more than By,hundred dollars($500).) ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 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.uNlis
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.06 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
ments are notinteaded 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 ofproving 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 Omar
❑ I,as owner of.the property,am exclusively contracting with - V.B. .00 O
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 6ASSESSORS 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
the Can tractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iumelempt under Seereas .
on ,B.&P.C.for this - WATER HEATER W/VENT 6.00
Owner 61 Date - WATER SYSTEM 5.00 - ACC.DATE ACG FILE NO.
WORKF:RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self-Insure,
or a certificate of Workers`Compensation Insurance,or a certified ZONING ENG-SITE NO.
copy thereof(Sec.3800,Lab,C.L '
Policy No. Company - - -
0 ❑ Certified copy is hereby furnished. FIRE SPgINK ENERGY T.24
Z Z ❑ Certified copy is filed with the city inspection division.
pO Applicant MISC-- REFER TO ORD. Y [:) NY (] .NE]
= y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE. PLG.CONTR. - LIC.NO. PLG.
O '(This section need not'be completed if fit, permit i for One TOTAL Y❑ N❑ V No
L) 2 hundred dollars(S 100)or less.)
U 0' 1 certify that in the performance of the work for'which this per- CITY . MECHANICAL PERMIT t FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner,So as to y ,
O
0 become subject to the Workers Compensation Laws of California. '
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING Q
} W NOTICE TO APPLICANT: If,slier making this Certificate of F.x-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE ` • 5.00 PLAN CHECK
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)Oo0QF.M.) 4.00
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 01e work for which this permit is issued(Sea MICROFILM
3097,Civ.CL .I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address - HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
. 1 certify that I havii read this application and state that the above' VENTILATION FAN (SINGLE) 4.00
information is correct I'agree to comply with all city and w in tY PLUMBING
ordinances gad State laws relating to building construction, and BOILER-COMP(3H.P-or 100,000B.T.U.) 6.00
hereby authorize representatives ins inspection
this city to enter upon the BOILER-COMP-love,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property tativsp of
puity I..
(We) agree to save, indemnify and keep harmless [he City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which CONST.TAX
may in any way accrue against said City in cousequenee.ef the PERMIT ISSUANCE 10.00
gran ng Of this p¢rm' -p MECH:CONT. LIC.NO. MECH.
r9" Z TOTAL TOTAL
gnatureof Appii [/Contractor Data.
OFFICECOPV" -