14141 POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO 14141
INSPECTION DIVISION
JOB INSPECTION RECORD.
PERMIT EXPIRATION
JOB ADDRESS 10371 PRUNETREE LANE _ UNIT# Lor#
PERMIT EXPIRES IF WORK
OWNER MARGE BEST CONTRACTOR PAUL WALTERS BUILDER IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB r Ilylr
PLUMBING
ELECTRICAL G ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH.
N0= ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION $IFT.
PLUMBING -
v -
MECHANICAL
ELECTRICAL PERMITTO - ,4
FRAMING - w ` �
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS 8EEN SIGNED
\ SO.fL FLOOR PHEP TOTALACREAGE
ROOF
DIAPHRAGM
- - BUILDING USE
RES IND CON PB Olner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ O El 1:1 1:1
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC,FILE NO.
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION - ...,[- PLUMBING
GAS
FIRE SPRINK ENERGYT24
MECHANICAL Yo
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING IN[] NE]
LATH-INTERIOR ELECTRICAL FLOOD ZONE A,L11C.
LATH-EXTERIOR FIRE DEPT. Y❑, N[] Y0 N�
SHEETROCK 7 GRADE FEE SUMMARY
SHEAR INTERIOR, BUILDING lit-1-87
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z' — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE e TOTAL 5 r
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
PERMIT NUMBER
BUILDING
A°°o3 '7Ruv 14141
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAMEM 9 _ OTY. ELECTRIC PERMIT FEE
1 1 TPXONE /
NAMERAcroRsI�L UTLETS-SWITCHES-RECEP 10.00/1.00
Vl_ �( pv J11c1ND SQ�4i8 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS APPLIANCES•RESIDENTIAL 4.00
1 /•��
PHONF _ f9l PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO,
ENGINEER
LIC.No. SIGNS TRANS. 3.00
-ARCW 08 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 n _
APPLICANTS MOTORS SEE FEE SCH. � �Rf^-�
ADDRESS '"'""ff��I
!P QOWx, SERVICE CHANGE 20.00 Ir
woo LICENSED CONTRACTORS DECLARATION I 1
IS i u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
v, ¢ n (commencing with Section 7000)of Division 3 of the Bu ass and BLDG. ELECT. PLG. MECH.
r M w Professions Cod nd my license is in full f ,�yr'[(AgMyrt
D'� - License Cla L,,,I,n mber0 11 L� e�j El
o z r Ww Date Contractor
P: x f BUILDING PERMIT
¢ ¢ a OW
R-BUILDER DECLARATION
¢ a v INFORMATION
w ; 1- 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION S/FT.
1- LL O¢ Law for the following reason.(Sec.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 �)
Code:Any city or county which requires a permit to construct,alter, nY�
ELEC.CONTR. LIC.NO,
a W ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC. ( `
iO, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w og he is licensed pursuant to the provisions of the Contractor's License /
r z i Law.(Chapter 9(commencingwith Section 7000)of Division3of the SK EL/ -
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
ce r O the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant toa civil penally ALTER -WATER (EA.) 5.00
-
of not more than five hundred dollars($5000.):
❑ I,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 (Scc. 7044, Business and ProfessionsDRAINS-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 does such work FIXTURES•PER TRAP 5.00SD.FT.FLOOR AREA TOTAL ACREAGE
himself'or through his own employees,provided that such improve.
! meals are not intended or offered for sale.If,however,(lie building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
RES IND CON PB Omer
Prove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the property,he exclusively. 7044,Bu with ❑ 1:1 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 s th docs not apply
co an owner of propertyh projects
who builds tr improves used pa and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such cense L with a comractnr(s)licensed punuanl to SEWER-SANITARY-STORM EA.200ft/10,00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.Ibr Ibis WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO,
WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy there 1po y /vr+ ��.D
Policy there
puny-I -
Q ❑ Certified copy ns creby furnished.
Z Z Certifi opyy is b wi inspection division.y FIRE SPR INK ENERGY T-Z4
O A phcantllL. Ii MISC.- REFER TO ORD. v N Y ❑ N�
jw CE RTIFICATE OF EXEMPTION I7ROM WORK ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU C'OAIPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG,
�
Z( This section need not be completed if the permit is for one TOTAL Y 13 N D Y E] N
hundred dollars 1$100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mitis issued,I shall not employ any person in any manner so as to
O become subject to the Workers'Compensation Laws of California.
U n Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3C:)_J2
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
2 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=11F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=11F.M.) 6.00 SEISMIC FEE .z
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(See. MICROFILM
3097,Civ,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
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 eonstRICllon, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP(Over 700,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,in'
gme costs and expenses which CONST.TAX
ma way accrue,againstd lily in consequence of the PERMIT ISSUANCE 10.00
grang of[hl 'L MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL }-41/-1
Sigt re of Applicant/Contractor I .te
OFFICECOPY -