14701 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF- CUPERT,INO 1701
INSPECTION DIVISION '
JOB INSPECTION RECORD
- PERMIT EXPIRATION
JOB ADDRESS '10055 MILLER vwrxb. - _LOT#
PERMIT EXPIRES IF WORK
OWNER Kontrabecki CONTRACTOR Therma IS NOT STARTED WITHIN
INSPECTION ' DATE INSPECTOR INSPECTION RECORD 180 DAYS OF P.ERMIT ISSU-
FOUNDATION -ANCE OR 180 DAYS FROM
,
LAST CALLED INSPECTION.
NOTE:
LIFER : - ALL GRADING AND DRAINAGE .�� .BE INSTALLED
PREGUNITE - TO COMPLY WITH•THE APPROVEO_ AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. '
GARAGE SCABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r; W•
UNDERGROUND.
/SLAB
PLUMBING
ELECTRICAL - F _
'ISSUANCE DATE
MECHANICAL - BLDG ELECT,I PLG. MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT Ifth
'-
WOOD FLOOR p INFORMATION PLUMBING VALUATION S/FT.
' - - � _ , Sti•,�„,
MECHANICAL - F�
ELECTRICAL ,. veamlT ro
FRAMING Ct ofUpDstn°: +=
INSULATION - - - STORIES TYPE CONSTR.
OCC'GHOUP RES UNITS
?:
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED se FT aooR Aei TOTAL Acaenee
V ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
y DIAPHRAGM . THE CONSTRUCTION TAXISPAID
roe BUILDING USE
ROOF SHEATHING RES IND CON Pd 00'.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INS07 ❑ ❑ ❑ ❑ ❑
ASSESSORS FARCE
.ROUGH. SAN.k LNO
PLUMBING . ELECT.ENERGY'
rHACi N0. PARCEL N0.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL ” MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING • - 'ELECT.-FINAL-TEST
INSULATION PLUMBING . - zoNiNc END SITE NO. .
. GAS TEST - GAS
MECHANICAL .. FIRE SPRINK ENERGY T]A
COVER NO WORK UNTIL ABOVE,HAS BEEN SIGNED HEATING E] "❑ E] NE],
FLOOD ZONE A.LUC.
• EXTERIOR SHEAR . ELECTRICAL RELEASE -
INTERIOR SHEAR FIRE DEPT, - Y ❑ N❑ Y ❑ N❑
SHEETROCK GRADE , FEESUMMARY
EXTERIOR LATH, BUILDING
INTERIOR LATH - TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC , PLANCHECK
GAS . .. _. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL.BUILDING FINALAS SIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU -ONE• 'ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING a,
)' _ O PLEASE GIVE JOB ADDRESS WHEN PHONING. -�
�243Z — SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! covsT.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
dIJI LDI NG PROJECT I DENTI FICATI ONPERMIT NUMBER
eWLOING . APPLICATION & PERMIT 4 I
A 7O
ADDRESS
1G7Z�5 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL a.
OWNER
'5 - PLAN CHECK.VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
E / PHONE
NgMERacroas ^^ UTLETS-SWITCHES-RECEP 10.00/1.00
E A °' Ltc.No.2 Q�1'� LIGHTING FIXTURES 10.00/1.00 .
Doffs
ADDRESS - PPLIANCES-RESIDENTIAL 4.00
0S1P_JN6KA000 AK.NE*33-557 PANELS 10.00 "DATE OFrAPPLICATION
ancwrSCTPANELS IOVER 200 AMP) - 20.00 PLAN CHECK FEE -'P.C.No.
Ofl
ENGINEER -
uc.No. ]SIGNS TRANS. 3.00 -
ADDRRESS ENG, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 -:�X
APPLICANT'SMOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE . 20.00 - r
-09 LICENSED CONTRACTORS DECLARATION
a u U 1 hereby affirm find I run lieensed under provisions of Chapter 9 - ISSUANCE DATE.
y z w (commencing with Section 7000)of Division 3 of the Business and
Q > g SLOG. ELECT. PLG. MECH.
H m i Professions Code,and my licen Li is in full forf�e Iapd f,��ec�.�q� ❑ ❑ ❑
z Z y G� License Class Lin.Number "'FU &/ -
g / Date 1'—•1�--Contractor &Mwj Jet '
-'sty re -f BUILDING PERMIT
o:a OWNER-BUILDER DECLARATION
a o a v - INFORMATION
w ;u-I- I hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
M VALUATION $/FT.
H LL o J Law for the following reason.(Sen. ,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city ar county which requuiresires ao permit to construct,eller,
0ac ce improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. k
C u requires the applicant for such permit m file a signed statement that TOTAL PERMITTO
n W'm a he is licensed pursuant to the provisions of the Contractor's License
Fz >
Law(Chapter 9(cmnmencingwitlr Section 7000)of Division 3 ofthe ALB�`
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
is. by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATERT
of not more than five hundred dollars(S500).):
❑ 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 offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR;ROOF,AREASPW. 0 i
- Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work 3 FIXTURES-PER TRAP S.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.If,however,the building f GAS-EA.SYSTEM-1INC.4 OUT
or improvement is sold wilhin'one year of completion, the owner- SYSTEM-OVER 4(EA. 2.00
builder will have the burden of proving that he did not build Or iceGAS-EA.
- BUILDING USE ,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB ' Ober
ftI,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
_ 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
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lot such projects with a contractor(s)licensed pursuant to
[tie Contractor's License Law. _ SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT No. PAROELNO.
'❑ I amexempt under Sec. - .B.&P.C.for this WATER HEATER W/VENT - 6.00 6 '—
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE. ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 .
1 hereby affirm.that I have a certificate of consent to sel Ginsure,' ' ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800(0j,,jj,,ab.CJ.
Policy NoSC O/o51/h}I(pany
O . ❑ Certified copy is hereby fumishedl FIRE SPRINK ENERGY T24
Z of Certifi coy is f with W cit 'inspection division. Misc.- REFER TO ORD.
Appheam-�,e-s}�/p Y ❑ N❑ Y ❑ No
m L/ PERMIT ISSUANCE 10.00
0: CERTIFICATE OF FXEMPTIO ROM WORKERS' FLOOD ZONE A.L.U.C.
LU - C04ENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
0 (This section need not be completed if fire permit is for enc - TOTAL (to Y❑ N❑ Y❑ N❑
hundred dollars is 100)or less.)
• U O 1 certify Bud in the Perfomsanca•of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL alit is issued, I shall not employ any person in any manner so as to
become�su�b�'g f�o,}I Workers'C- npensation iofC itorni -
Date-2�d?-1(�Applicant' - BUILDING '
a ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,aflir n ng this Certil'ical Iix-
Z emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must I'orlbwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
life performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG U N IT(OV ER 100,000 B.T.U.)9.50
Lenders Address ELECTRIC
I certify Ilial I have read this application and state Ihot the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city unit county PLUMBING
ordinances and stale laws relating to building construction;and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the 801 LER•COMP (C.,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property 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 which PERMIT ISSUANCE 10.001CONST.TAX
may in any way accrue against said City in consequence of the
ranting of this permit MECH,CONT. LIC.NO. MECH.
- ,� TOTAL TOTAL
store licun[ ontraclor Data
OFFICE COPY