14612 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPFRTINO
14612
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10290 DENISON AVE. UNIT# _LOTtt '
PERMIT EXPIRES IF WORK
OWNER RUDEK CONTRACTOR A & H HEATING IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:.-
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. ,'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAI_IU N
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB I .
PLUMBING
ELECTRICAL ISSUANCE OAT
MECHANICAL BI-OG. ELECT.I PLG. MECR.
❑ -T❑ ❑ 0
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
pq►D INFORMATION
WOOD FLOOR - VALIATION SIFT.
PLUMBING - +
MECHANICAL FU q e 1
ELECTRICAL p PeRMn ro
FRAMING . . city of,
STORIES TYPE CONSTR. !
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
.� - ROOF NOTE:NO FINAL INSR SHALL BE MADE BEFORE. SO.I T.Fi 10l+ IIIA TOTAL.ACB IAGI
DIAPHRAGM THE CONSTRUCTION TAXISPAID
BUILDING USE
ROOF SHEATHING ❑ ❑ ❑N ❑ O❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PnaceL No
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACI No. . PARC[L NO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY /-
ACC DATE ACL.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING . - ELECT.FINAL TEST -
ZONING ENG.SITE NO.
INSULATION - PLUMBING z
GAS TEST GAS
FIRE 51'fl INK ENERGY T.24
' MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING rj'� ;�vk, N❑, 'v "o
.FLoou zorvE a L U.C.
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING A/1 _ ..
INTERIOR LATH - TEMPORARY APPROVALS ' BUILDING - '
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
OONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB-ADDRESS WHEN HEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
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 I DENT[FICATION -
PERMIT NUMBER
ItILDINGDRESS APPLICATION & PERMIT 14612
ADDRESS
10c,291)
v pf,�� BUILDING — ELECTRICAL—PLUMBING —MECHANICAL
OWNER'S r�rv�
�ee../�� PLAN CHECK VALIDATION
lza') l _ TY. ELECTRIC PERMIT FEE '
/` ,GrCi vHON
CONTRACTOR'S
NAME � OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC,NO LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
. Aj,/f,RlD FTSE //�J
! PANELS 10.00 DATE OF APPLICATION
ARCRITECT PLAN CHECK FEE - - P.C.NO.
on PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No, SIGNS TRANS. 3.00
ADDRESS ENG. PERMIT 5.00 - PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT s MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
00 LICENSED CONTRACTORS DECLARATION 7/-q////
U v I hereby at that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
e_ (COnunemc;ng with Section 7000)0(1)ivision 3 ,fl rn Business unA
rn D n BLDG. ELECT. PLG. MECH.
_ r N i I'rolessil RE— is in lull� ❑
z o m ccn f7.� Llc.Nmnbc'
o — lulu sL Cnlnmoor -
a Y E
rc ¢
OWNER-BUILDER UIiCLARATION BUILDING PERMIT
a a a INFORMATION
La 3 LL I hereby affirnh that I am exempt from the Contractor's License MISC.— REFER TO ORD
La u o v, Law for the following reason.(Sec 7031.5,Bu,fim,, ad Professions PERMIT ISSUANCE 10.00 VALUATION
Code:Any city or county which requires a permit to construct,alter,
Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License
rzQLaw(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
4 O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M I- m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ca sem _ by any applicant for a permit subjects the applicant tna civil penalty ALTER-DRAIN (EA.15.00
of not more than five hundred dollars($500).): '
❑ 1,as owner of the property,or my enhployees with wages as BACK FLOW PROTECT. DEVICE 400
their sole mmpensalion,will do the work,and th .
e structure is not OCC.GROUP RES.UNITS
Intended or Offered for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's Uccnse Law does not apply to an owner of
properly who builds or improves themon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himsell or through his own employees:provided thin such improve-
ments are not intended or offered for sale.It,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 SEA) 200 BUILDING USE
builder will have life burden of proving that h - . - . .
e did not build or im- RES IND CON PB ower
th
prove for purpose ofseJ' INDUSTRIAL WASTE INTER. 30.00 El ❑ E ED 1:1❑ I,as owner of the properly,am exclusively contracting with
licensed Contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Cmfomlor'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 SEWER-SANITARY-STORM EA.200ft
the CONmelofs License Law. /10,00 TRACT NO. PARCEL NO.
❑ lain exempt under See.—,B&KC,for this WATER HEATER W/VENT 6.00
reason
Owner oma WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKRRS'COMPENSATION DECLARAI-ION WATER TREATING EQUIP. 5.00
I herchy affirm that 1 have a certificate of consent to self Home. ZONING ENG.SITE NO.
or a enil'ieule of Workers'Compensaliun Innunmec,or a e,rtifi,,l
cohysthe
Policy N Cy
❑ Certified copy is hereby furnished. �SMCAL FIRE SPRINK ENERGY T�4
Z Z CCrtific c y e _ py in,cpccl lop shoo.
O I leant i`"�b MISC.- REFER TO ORD. YE] N� Y ❑ N[D
~ PERMIT ISSUANCE 10.00
fry— CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.II.C.
IL COIs1Pot be 106'INSURANCE PLG.CONTR. - UN
C. O. PLG. ❑ ❑ ❑ ❑
CL O (This section need not be completeA if the permit is for one TOTAL Y N Y N
� Z hundred dollars f5100)or less.)
U O 1 certily that in the performance 01'the work Ii,r which this PCr- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mil is issued.I shall not employ any person in any manner so as to
U W become subject to the Workers'Compensation Laws of California. -
Date—Applicant - ALTER OR ADD TO MECH. ,00 BUILDING
} m NOTICE '10 APPLICANT: If,after nhaking this Certificate of Ex-
�,Z cospton,you should become subject to the Workers Compensation APPLIANCE 5 00 PLAN CHECK
provisions of the Labor Code, you must 1011hw1th comply with FEE
U noel(Provisions or this permil shall be dec,oM revoked. AIR HANDLING UNIT(TO 10,000 :00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.EM.) SEISMIC FEE
I hereby affirn, that there is a construction lending agency forEXHAUST HOOD (WITH DUCT) . .0
the performance of the work for which Ibis permit is issued fSec. O MICROFILM
3097,Civ.C.l.
Lender's NaHEATING UNIT(TO 100,000 B.T.U.) 8.00
me HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. information is street. I agree Cl ti comply with a0 city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building onstrand co and
hereby eutlmrixe representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly 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 whichCONST.TAX
may is any way incense 'gainit said Clly in consequence of the PERMIT ISSUANCE 10.00 /3
•ru ti gof this permil MECH.CONT. LIC.NO. MECH.
/' TOTALOP TOTAL
S mture of Applicant/Cont ' r ate L �Q �
OFFICE COPY