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13079 POST THIS RD NEAR FRONT OF BUILDING • RMITNUMBER CIWOF CUPERTINO. V ' INSPECTION DIVISION 13079 JOBINSPECTION RECORD PERMIT EXPIRATION 'JOB ADDRESS 10490 San Felipe UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS.NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 160 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 160 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION - , r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PLUMBING UNDERGROUND /SLAB ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG. ELECT. PLG. MECH. ❑ E:] ❑ E3 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL P, ELECTRICAL PER Ir o • FRAMING - 5,' , INSULATION J;\� �J STp`I I TYPE CONSTR. � � � trUDe .r:: OCC'GROU f RES.UNITS 4• PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT.FLOOHARF,A TOTAL ACREAGE DIAPHRAGM BUILDING USE - RES IND CON PR Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING ur - . . - TRACT NO. PARCEL NO. GAS TEST MECHANICAL - ELECTRICAL FINALS DATE INSP. ACC DATE ACG FILE NO. FRAMING SAN Z01NN6 ENG_SITENO. - INSULATION � PLUMBING ..+,I�.�:, �� GAS MECHANICAL .FIRE SPRINK ENERGY TR9' ❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N❑ N❑ LATH-INTERIOR ELECTRICAL FLOOD ZONE A.LLLC.-� LATH-EXTERIOR FIRE DEPT, v❑ NE] Yo N❑. SHEETROCK - GRADE, FEE SUMMARY SHEAR INTERIOR BUILDING - - SHEAR EXTERIOR .TEMPORARY APPROVALS .BUILDING, FIREWALLS ELECTRIC PLAN CHECK GAS FEE- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED I OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHON=252-4505 ELECTRIC �� ONE WORKING DAY BEFORE REQUIRPLUMBING z PLEASE GIVE JOB ADDRESS WHEN PH — SEE PERMIT FOR EXPIRATIOMECHANICAL .. I. CONST.TAX 'IMPORTANT! PLEASE READ REVERSE SIDE BEFORE, TOTAL CALLING FOR FINAL INSPECTION. ' OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - LISWLL ALL POINT PEN ONLY w' BUI LDI NG PROJECT I DENTI FI ON PERMIr NumBER BUILDING APPLICATION & PERMIT 13079 aD EESs BUILDING—ELECTRICAL—PLUMBING—MECHANICAL �D �F .v OWNER'S - PLAN CHECK VALIDATION NAMEA /f _ c QTY. ELECTRIC PERMIT FEE /7 /7'�Oy VNDNE r CONTRACTORS , OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME 'A 12e41KY MGil* uc.NO. `IL LIGHTING FIXTURES 10.00/1.00 COONTRA TORS /I p PPLIANCES-RESIDENTIAL 4.00 7 S / V l "1✓ PHONE L{_/�1 y PANELS 10.00 DATE OF APPLICATION RCHrtECTPANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO. OR , ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH. oo Ess ENc' SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ASMOTORS SEE FEE SCH. ADDREDDRESSS SERVICE CHANGE ` 20.00 Woo LICENSED CONTRACTORS DECLARATION is u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE D iw (commencing with Section 7000),,f Division 3 of the Buslneas and BLDG. ELECT- PLG. MECH. Professions Cpde alsll n J�c;, is in full forge pn a '4 t o 0 w o Licen Chas /• i,Numbst 4 1 H w Dale CoNractorM R @E;3_ a x f C/^=• BUILDING PERMIT a a a OWNER-BUILDER'DECLARATION o it v INFORMATION w ;LL N icense I hereby affirm that I am exempt from the Contractor's LMISC.- REFER TO ORD VALUATION $/FT. Hu Oa Law for the following mason.(Sec.7031.5,Business and professions PERMIT ISSUANCE 10.00 Code:Any city or county which requiresa permit toconstrucq alter, Le ¢Q Q improve,demolish,or repair any Structure,prior to its iasmamr,also ELEC.CONTE. LIC.NO. ELEC. iL m u requires the applicant for such permit to file a signed st Btument that TOTAL PERMIT TO w he is licensed pursuant to the provisions of the Contractor's License )� Hii Law(Chapter 9(commencing with Section 7000)of Division 3 of the i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE M H i� the basis for file alleged exemption.Any violation of Seetion 7031.5 STORIES TYPE CONSTR. by any applicant fora permit subjects the applicant toucivilpenalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars($5001.): ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their Sale compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-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 5.00 SO.Pr.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided thmsuch improve- ments are not intended or offered forsale.If,however,the building Of improbur vement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA) 2,00 builder will have the den of proving that h - . - . e did not build nr im- BUILDING USE prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 RES IND CON pa Otha, ❑ I,as owner of the property,San 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 for'such projects with a contmctoris)licensed pursuant to SEWER-SAN V-STORM EA.200it/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I um exempt under Sec.—,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION_ WATER TREATING EOUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company Q ❑ Cet]ified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is Bled with the city inspection division. MISC.- REFER TO ORD. Or Applicant Y ❑ N❑ Y C] N❑ ~ of PERMIT ISSUANCE 10.00 LU — CERTIFICATE OF EXEM19'INS FROM WORKERS' FLOOD ZONE A.L.U.C. W COM am be IONcoo INSURANCE PLO.CONTE. LIC.NO. PLG. Y❑ N❑ Y❑ N❑ D Z (This sectidn need not be completed if the permit is for one TOTAL hundred dolbus($100)nr less.) U O I certify that in the performance of the work for which this per- Q Y MECHANICAL PERMIT FEE FEE SUMMARY LL I— mil¢iss ed,I shall not employ a ry pe on in an ma cr so as to O W Beco Let rn Workers 'on a=ilbrnia. y Date^ Applicant ALTER OR ADD TO H. 5.00 BUILDING } US NOTI TO APPLICANT: 1 , fuer m: n his tificute of Ex- Fz empli mymu should become subject tt I orkers'Compensatiun 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)_ GF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING NIT:(OVER 10p��,0r�0r Q.F .16.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOQD-(WITH .Y 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT( 1,60;0 0 B.T.U.) 8.00 — Leoder' AddNamHEATING UN IT(O ER 100,000 B.T.U.)9,50 Lender'sxAddress 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 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 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for i 3 cy inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Babilitics,jud bents, costs and expenses which PERMIT ISSUANCE 10.00 O -� CONST.TAX may I any way accrue-agai id City in consequence of the gm gof �PmII. MECH.CONT, LIC.NO. MECH. TOTAL �` 7 TOTAL \X- h ature of an[/'o tactor O(Daatte"��/ OFFICE COPY