14135 (2) POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PFRA9iT NUMBER
INSPECTION DIVISION 1 41 35
JOB INSPECTION RECORD
' PERMIT EXPIRATION
JOB ADDRESS 21550 EDWARD WAY UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER GORDON JONES CONTRACTOR KEVIN HUNTER ELECTRIC IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
LIFER - LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLuc. ELECT. PLc. MECH.
❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR BUILDING
TION $/FT.
PLUMBING VALUA
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION §TORIES rYPECONSTR.
OCC.GROUP RES UNITS 1
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO FT FLOOR ARE- i01AL ACREAGE
DIAPHRAGM
BUILDING U§E
RE$ IND CON P9 CHI-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
AS§ESSOHS PA RCE.NO
ROUGH I
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICALACC.DATE ACC.FILEND.
,� FINALS ZDATEINSP.FRAMING SAN #INSULATION PLUMBINGGAS
MECHANICALFIRE SPRINK ENERGY T.11
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGY ❑ N❑ Y ❑ N❑LATH—INTERIOR ELECTRICA 1?Y' FLOOD20NE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK IGRADE FEE SUMMARY
SHEAR INTERIOR IBUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS IELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ti
~O� 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
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
7ZR5_BUILDING APPLICATION & PERMIT
o[o
0 EDWN2,D WAy BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14135
OWNER'S PLAN CHECK VALIDATION
NAME RJO NLS 44 OTY. ELECTRIC PERMIT FEE
CONTRACTORS 1'1 t hoRNR
PRONE 44-b-oZ b
CON
NAME LE.Gc-TV-L� Cl.li5p5 G10 UTLETS-SWITCHES-RECEP 10.00/1.00
�'1/IN N HU TE(Z LIC.NO• $ Sv pr LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE 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
AOOREss ENG. PERMIT CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AMOTORS SEEIFEE$CH.
DRESS E55
ADOR
SERVICE CHANGE 20.00
w O o LICENSED CON TRACTORS DECLARATION
rt U 1 hereby aifmn that Iain licensed Hider provisions of Ch.plc,9 ISSUANCE DA/TE
is
y¢ w (commencing with Section 7000)of Division 3 of the Business and
CT.BLDG. ELEPLG. MECH.
H y z Professions Codc,and my license is in full force and effect. nVII of me in
❑ ❑ ❑
z o H License Class Lie.Number
9 - Date Cnntructor
x f BUILDI G PERMIT
BE ¢ w OWNER-BUILDER DECLARATION INFORMATION
0 MISC.- REFER TO ORD
F.
g LL N I hereby affirm Thal I am exempt from the Contractor's License VALUATION
H , o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 .Q - $/FT.
wCode:Anycily orcounly which requiresa permit to construct,alter,
as Q 2 improve,demolish,Dr repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
0 ¢ requires the applicant for such permit to file a signed statement that TOTAL
n w m�` he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r
Hsi
Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe C 7
a Business and Professions Codc)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE /
$ the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
n by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(SS001.):
❑ 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 (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
S property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SG.ET FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
meets are not intended or offered for sale.If,however,the budding
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
p, c for purpose of sale.). TRIAL WASTE INTER. RES IND CON PB Omer
}p. I,as owner of the property,am exclusively contracting with INDUS30.00 El El El El Eltic nsed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'rhe 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 contractors)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
re.SO,
- owner Dale WATER SYSTEM 5.00 Ace DATE ACC.FILE NO.
WORKERS' MPI:NSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell'-insure,
or n certificate of WorkcrS'CompcnsaUon Insurance,or o certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lah.CJ.
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Hp Applicant rlTed copy is tiled with the city inspection division. MISC.- REFER TO ORD. Y ❑ N Y ❑ NEI
it CERTIFICATE OF FXEMP'I'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.II.C.
W (7041:NSA'1'ION INSURANCE PLG.CONTE. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL YE] N Y ❑ IN
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
W Date Applicant BUILDING
Is.>_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
? emption.you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Codc, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTR OCPION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
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,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(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 correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-(.XlMP13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP IOVBr t00,0008TU1 SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree lO 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 tbl,a peril. MECH.CONT. LIC.NO. MECH.
7 TOTAL TOTAL
mI Onlmclor - ate
OFFICE COPY