13171 POST THIS CARD NEAR FRONT OF BUILDING
• PPRMIT NUMBER
CITY. OF CUPERTINO 13171
INSPECTION DIVISION
JOB INSPECTION RECORD .,
1i, :�" tt
PERMIT;EXPIRATItlftt
1060 WESTHILL COURT r
JOB ADDRESS UNIT# LOT 4f M "PI
PAUL & DIANE TAI PERMIT EXPIRES IF WORK
OWNER CONTRACTOR' IC & C 15 NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR'180 DAYS FROM ,
UFER LASTCALLED INSPECTION.
PREGUNITE - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
j INFORMATION
WOOD FLOOR VALUATIONsiEr.
PLUMBING G
MECHANICAL
ELECTRICAL PERMIT To
FRAMING �-
INSULATION LoSTORIES TYPE CONSTR.
OCC.GROUP j. RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1Y
. ROOF SO,FT,PLOOR AREA `TOTAL ACREAGE
DIAPHRAGM4
BWL USE
lei CON
RES IND CON PB O�hm
,.APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ Q
ROUGH ASSESSURS PARCE L NO
PLUMBING
GAS"TEST' �� A�/y' O G� Tancr,rvo. PARCEL NO
MECHANICAL , ).�Q- Aag. SAL(/-'U
ELECTRICAL �f� FINALS DATE INSP. ACC.DATE nca FR.E No.
FRAMING SAN 0
ZONING ENG.SITE NO.
INSULATION PLUMBING
N 3 GAS
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y I] N[:] Y ❑ NE)
LATH-INTERIOR ELECTRICAL FLOOD ZONE A,L.U.C.
LATH-EXTERIOR FIRE DEPT. Yo No 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 OCCUPANCY SEISMIC FEE !�d
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LD'- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z° PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL �-
CALLING FOR FINAL INSPECTION.
OFFICE COPY '
A.
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
AOOREss® BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 13171
OWNER'B ��.1� O/A,/LL PLAN CHECK VALIDATION
NAME 1, �+I .�/ e�� OTV. ELECTRIC PERMIT FEE
• A PHONE J5ZZ-I0 eN v 3
rvnme tuns r OUTLETS 10.00/1.00 � ^ IC
ACYL 3 cfG-7
uO.No. LIGHTING FIXTURES 10.00/1.00 O_
r..ONTRACTORs APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS ENG. PERMIT CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. _ 20.00 PAID
ADDRESS rs MOTORS EE FEE SCH.
ADDRESS
T
SERVICE CHANGE Ami-720.00 I� (1Q
,� � 1.,_1
w
02 LICENSED CONTRACTORS DECLARATION
wti, �3 8
¢ Ei w I hereby affirm that I am licensed under provisions of Chapter 9 US UAN fa,, no
N (commencing with Section 7000)of Division 3 of the Business and r
¢H Iry V SLOG, ELECT. PLG. MECH.
H m z Professions Code,and my license is in full force and effect. Y ❑ ❑ ❑ ❑
o i m W License Class Lie.Number
Date Contractor
a x E a BUILDING PERMIT
E o n U OWNER-BUILDER DECLARATION INFORMATION
w ; H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u_ 0 a Law for the following reason.(Sec.7031,5,Business and Ponies oms PERMIT ISSUANCE 10.00 O VALUATION $/FT.
wig Code:Any city orcounty which requiresa permit to construct,alter,
R ac ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
N wO¢ requires the applicant for such permit to file a signed statement that TOTAL 3 Q PERMIT TO
m°' he is licensed pursuer(to the provisions of the Contractor's License �{ ](0/ T`
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /-S Ll
¢ Business and Professions Code)or that he is exenspt therefrom and QTY. PLUMBING PERMIT FEE
¢ $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i3 by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN (EA.) 5.00
of not mom than five hundred dollars($511
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole cum Ptr
ensation,will do the work,and the sucture 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.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided(list such improve. GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
mems are not intended or offered for sale.IL however,the building
or improvement is sold within one year of completion,theowre.- GAS-EA.SYSTEM-OVER 4(EA.) 2,00
I builder will have the burden of proving that he did not build or im• BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 11 ❑ 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 Law does not Apply
to an owner of proppArty who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for sect /1Yejects with u contractut(sl licensed poreuant to
the Contractor'S Bae I,g�. SEWER-SAN V-STORM EA,200ft/10.00 TRACT IN PARCEL NO.
❑ tum axe t sder Sec. ___,B.&P.C.I'or his WATER HEATER W/VENT 8.00
reason
Owner Date _ - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG,SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thercof(Scc.3800,Lab.CJ.
Policy No. Company
0 ❑ Certified copy is hereby furnished.
FIRE SPR INK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.
MISC.- REFER TO ORD.
O Applicant Y E] ry 0 Y C] No
~ rnPERMIT ISSUANCE - 10.00
LU - CI>RTI EICCOI OF EXEMPTION FROM WORKERS' FLooO zorvE A.L.u.c.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This section need not be completed if the permit is for one TOTAL Y❑ N Y [:] N
D Z hundred dollars(5 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I,slmll not employ any person in any manner so as to
Ow become subject to the Workers Compensation Laws of California. BUILDING y�
C_ Date Applicant ALTER OR ADD TO MECH. 5.00
} so NOTICE TO APPLICANT; If,after making this Certificate of rix
I. E emption,you should become subject it,the Workers'Contpensalion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you mus( forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQO00C.EM.) 6.00 SEISMIC FEE ' 8O
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(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's AddHEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
mss
. 1 certify that 1 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-COMPI3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives AC this city es enter upon theabove- BOILER-COMP (over 100,0008TU)SEE FEESCH. MECHANICAL
hereby authorize
ned perry torinspofthi keep
(We) agree o ave, indemnify and keep harmless the City of MISC.- REFER TO ORD.
CupertinD a n liabilities 'ud ants, costs and expenses which CONST.TAX
may in an y cane Aga ns said City in corse acne of the PERMIT ISSUANCE 10.00
I
of is r '1. (7�� MECH.CONT. LIC.NO. TOTAL •�
SignatTmcfApplicam/Contractor Date TOTAL /
OFFICE COPY