12944 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO 12944
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 1035 Colony Hills Lane . ,UNIT# LOT# pERM17 EXPIRES IF WORK
OWNER coNrRAcroR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF,PERMIT ISSU.
FOUNDATION - ANCE OR 18Q DAYS FROM
LAST CALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,.
UNDERGROUND /SLAB /1
PLUMBING
ELECTRICAL ISSUANCE DAT
MECHANICAL
BLDG, ELECT, PLG. MECH.,
,
E3 ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - . vnwnnoN s/Fr.
PLUMBING +a I
MECHANICAL v cJ
•
ELECTRICAL-
PERMIT TO
FRAMING IRkR� R m- :,*tz—
STORIES TYPE.CONSTR,
INSULATION
S ; 3
OCC.GROUP RES.UNITS
IPLINCE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
w ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
w
DIAPHRAGM
_ BUILD USE
' HES IND CON
PB Olhx,
El' El El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ '
ASSESSORS PARCEL NO.
ROUGH
PLUMBING .
TRACT NO. PARCEL NO.
GAS TEST '
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS - DATE INSP.
' FRAMING - - SAN # ZONING ENG.SITE NO.
INSULATION- PLUMBING
dr.! GAS -
FIRE SPRINK ENERGYT-24
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v N E Y [:] N[]
LATH-INTERIOR ELECTRICAL PL000 ZONE A.L.u.c.
LATH-EXTERIOR FIRE DEPT. Y❑ NE] Y I] N
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPO RAR AP ROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS'BEEN SIGNED OCCUPANCY SEISMIC FEE '�j Ll
OCCUPANCY OF BUI LDI NG IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
zIJJ ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
� PLEASE GIVE JOB ADDRESS WHEN PHONING. ,
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE 8EFORE :I
TOTAL .
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATIOR PERMIT NUMBER
aDIDIND
APPLICATION & PERMIT 12944✓
ADDRE59
1a �• b1�Us BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OwNefla PLAN CHECK VALIDATION
"AME Ie/- QTY. ELECTRIC PERMIT FEE
a` r TIC PHONE
k CONTRACTOR's UTLETS-SWITCHES-RECEP 10.00/1.00
KMx ID.No. S LIGHTING FIXTURES 10.00/1.00
roNTRAcroR's •� PPLIANCES-RESIDENTIAL 4.00
AODIR + 'I' -a71
ISLI Co$ Ins 911K1 PHDNE 3;SG_q PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG, SPECIALCIRCUIT 5.00 PERMIT VALIDATION
AOORES9
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS A - MOTORS SEE FEE SCH.
OR /
SERVICE CHANGE 20.00 IS&V w
LICENSED CONTRACTORS DECLARATION 7o O `/ /�
a i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
yi Professions Code,and my license is in full late prld.ef act. �y ❑ ❑ ❑
2 o y- License CClass Lic.Number aa��4F �IPP'I-'P
of Dale 3/4 II�Contractor
Q y E J � BUILDING PERMIT
m w u OWNER-BUILDER DECLARATION INFORMATION
0 MISC.- REFER TO ORD
w g R. r 1 hereby affirm that 1 am exempt from the Contractor's License
VALUATION $/FT.
u o a Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE 10.00
� - Code:Any city or county which requires a permit to construct,alter,
Q Q¢Q improve,demolish,Or repair any Structure,prior to Its issuance,also ELEC.CONTR. LIC.NO. ELEC. f�'V
D LL requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO
E
8 w he is licensed pursuant to the provisions of the Contractor's License
Fz > Law(Chapter 9(comencingwithSection 7000)ofl)ivision3ofthe
ss
a
Bus new m
eand Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
It Ihebasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole 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
• properly who builds or improves thereon,and who doessuch work FIXTURES-PER TRAP 5.011 SO,FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM•1 INC.40UTLETS 8.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that lie did not build or im- . . .
RES IND CON PB OtM1er
. .
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000
❑ 1,as owner of the property,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 for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.OATE ACC.-FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificam of Consent to self-insure, ZONING ENG.SITE NO.
/ or a certificate of Workers'Compensation Insurance,or a certified
copy[her f(Sec. 00,Lab C. `-
PolicyNo. Company^�SyLK
O ❑ Certified cop Is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certife copy is filed wit a cit i action division. MISC.- REFER TO ORD, ❑ ❑ ❑ ❑
APPlCars- _ Y N Y N
~ mPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CERTIFICATE OF EXEMPTION FROM WORKERS'
_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
11 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y E] IN 1:1
D 2 hundred dollars($100)ar less.)
U O 1 certify that in the performance of 0m work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
IL mit is issued,I shall not employ any person in any manner so as to
��..,. become subject to the Workers'Compensation Laws of California.
0 w Date Applicant BUILDING gg (2
a - ALTER OR ADD TO MECH. 5.00 �V
} w NOTICE TO APPLICANT: If,after making this Certificate sa F,x-
F. ? or visions
you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10p00GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). i HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
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-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of Ibis city to enter upon theBOILER-COMP (Over 100,000 STU)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 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
granting of this permit _ MECH.CONT. LIC.NO. MECH. /�
1\/ TOTAL TOTAL --�
1`' SI u of Applicant ontractor Ua
OFFICECOPY '