17392POSTaTHIS CARD NEAR FRONT,OF BUILDING
PEPAUIT NUMBER
CITY OF - CUPERTINO ,,.'.
173f
' • INSPECTION DIVISION"
, .
JOB
JOB INSPECTION RECORD
~
PERMIT EXPIRATION
JOB ADDRESS Z -Z? yj tlAj•�UNIT#
E.-
•_LOT
PERMIT EXPIRES IF WORK
owrvER 0 L f-' '�Ap rRACTOH; '. '•'r y<:
IS NOT STARTED. WITHIN
160 DAYS OF' PERMIT ISSU-
ANCE OR 160 DAYS FROM ,.
- LAST,CALLED INSPECTION.
INSPECTION
- DATE
INSPECTOR
• INSPECTION RECORD
-
FOUN DATION �C,
,,
NOTE:, "
+
�s.
LIFER �
-
AG
ALL GRADING AND DRAINAGE SHALL BE INSTALLED'
TO COMPLY WITH THE APPROVED PLANS AND CITY, OF
- ' 4.
PREGUNITE-
-
•,APE LIMIT VALIDATION' -
,
CUPERTINO STANDARDS. ; ' •
-"
..C"'
,�tg(...�
''
GARAGE SLABS' ' -
''
,.POUR NO CONCRETE UNTIL ABOVE HAS BEEN
SIGNED
_ ., uAD'� ���J
_ MAR
' •'. UNDERGROUND /SLAB
_- / T
�•:,J.0 C VV�A vv& ,r
PLUMBING
- -
-
ELECTRICAL
-
.� , .
sf'
TE
MECHANICAL
•.
..
BLUE„
ELECT.
,. LG. m[cH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
ry UI'
-
BUILDING PERMIT
INFORMATION
.VALUATION
FLOOR
$JFT.
'
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING
'�.
INSULATION
STORIES
TYPE CONSITO
• -
1 ,,
OCC G11DDP
ES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' .,ROOF -
NOTE: NO FINAL INSP: SHALL BE MADE BEFORE, -
THE CONSTRUCTION ?AX IS PAID • • _
_
-�.' ••, '.,(
•
SO IT.FLOORPREP
TOTAL ACREAGE
• . .'
DIAPHRAGM
•
ROOFSHEATHING
•' •4 ''
�,F`'
BUILDING USE -
HE IND CON PB Do—
• 0 ❑ ❑ ' ❑" L
,APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS-
DATE
ANSP.• .
ROUGH'
SAN.N'
'ASSESSOHs PARCEL NO
PLUMBING
ELECT. ENERGY,
TUBS 8 SHOWER PAN
�
�
PLUMBING ENERGY �
�
. .
TRACT NO
—
PARCEL NO.'.
MECHANICAL
-
MECH. ENERGY•'. j r,
ELECTRICAL.
-
BUILDING ENERGY
ACC DATE
:ACC. FILE NO
'
'FRAMING -
"- -
ELECT. FINAL - TEST -,.
INSULATION
PLUMBING.
ZONING
•"
ENG. SITE NO.
GAS TEST.'
GAS
-
MECHANICAL
'EIRESPRINK
ENERGY Tao
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING•,
EXTERIOR SHEAR
ELECTRICAL RELEASE
-
FLUUULONE
'v.Q. ,m❑
A.L.U.C.
, v (� N❑
INTERIOR, SHEAR -
(
FIRE DEPT.. -
SHEETROCK' _
.GRADE
FEE SUMMARY
EXTERIOR LATH.
BUILDING
-
BUILDING
INTERIOR LATH,',
-
,'TEMPORARY APP VALS -
SCRATCH COAT
-
ELECTRIC.
PLAN CHECK
FEE
Y•�!•
•
GAS A. ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY,
SEISMIC FEE.h_
.,i
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAEISSIGNED BY BUILDING INSPECTOR.
.
,MICROFILM •�^
-•�.,�
ARRANGE FOR INSPECTION.BY PHONING -252 -4505,
s
ELECTRIC ,
Lu
— ONE WORKING DAY BEFORE REQUIRED INSPECTION.:
PLUMBING
00 PLEASE GIVE-JOB.ADDRESS WHEN PHONING.
MECHANICAL ,..,'
—• `
• —SEE PERMIT FOR EXPIRATION DATE-- . -. I•
-
CONST'TAX
---
:IMPORTANT.!
TOTAL
PLEAS E'READ REVERSE 'SIDE BEFORE
CALLING FOR FINAL INSPECTION:
OF.FICE'COPY
APPLLCANT TO FILL IN INFORMATION WITHIN REDLINES - USE.BALL•POINT PEN ONLY
l
LDING PROJECT,(DENTI F.ICATION
-
PERMIT NUMBER
".
APPLICATION &PERMIT _ •. ''
f"
BUILDING:— ELECTRICAL— PLUMBING — MECHANICAL
,
17 /'S1 Q I' /')
. -• ', 1 "I V 92 -
m LOING „
ADNESG
AooRESS .j'
OZ�
(,
9NAME _ /MS�S� •
TV.
..
ELECTRIC PERMIT "
FEE 1
PLAN CHECKVALIDATION
."
r.
-
s t
OUTLETS - SWITCHES - RECEP 10.00/1.60
- •uc: No ".
LIGHTING FIXTURES ,.10.00/1.00
,
.• _
ADDRESSTOR's y -
-
PPLIANCES - RESIDENTIAL' 4.00
PANELS 'A 1 10.00
- PHONE
'DATE OF APPLICATION 1
ARCHITECT -
oR
ENGINEER
' LIG Na,
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.0 "NO. .
_
-
SIGNS TRANS. 3.00
ARCH, OR ADDRESS ENG. ' '^
SPECIAL CIRCUIT 5,OD
�
PERMIT VALIDATION '
MP. METER OR•POLE INS. - +20.00
• I nP
�� `.
APPLICANT jQLS/Q S ai
SEE FEE SCH:
'
.'20.00'
"
LICENSEDCONTRACTORSDLCLARATION iy
I herchy affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of Ilse Business'aa,]
Professions Cci and my license is in full force and effect
I-i,c, Class Conract.,r
Date Contractor
RRRVIC�CHANGIE�'
+
- UL:J
ISSUANCE GATE
BLDG.- ELECT, PLG. ' MECH.
EJ
�f� �.4i.�
^ity oVYAR
{I L01lIY
OWNIi R- RUILDER DECLn ItAT10N
I hereby affirm that 1 am exempt from the Contractor's License
Law for the following reason. (Sec. 703 1.5, Buseress:ud Professions
C county which structur e permit construct, alter,
BUILDING PERMIT
INFORMATION
REFER TO ORD
PERMIT ISSUANCE ,• ip,00
r
VALUATION
UA
0
$ /FT.
ELEC. CONTR, _IC. N0.
- - --
ELEG
TOTAL
prove, d mulish
improve, demolish, or repair any structure, prior to its issuance, also
o Sho
requires the applicant for such perm l,tn file a signed statement that
he Is licensed Pursuant to the provisions ofthe Contractor's License
I.aw,(Clmpter9(comm(ncingwilh Seetion7000)of Uivision3ofthe':
Business and Professions Code) or that he is exempt therefrom and
_
�
-
,
11C. 1� 0,
D W`V V
-
OTV.
"' -
PLUMBING PERMIT
FEE
file basis for the alleged exenrptinn. Any violation of Section 703L5
by any applicant for a permit subjects the applicant to a civil penalty,
of not more than five hundred duple, (5500).):
.'. - .,f ;-
STORIES
; ".;TYPE CONSTR.
'
gLTER- DRAIN &VENT -WATER (EA.) 5.00
❑ 1, as owner of the properly, F my employees with wages as
their sole compensation, will do the work, and the structure is not
ggCK FLOW PROTECT. DEVICE 4,00
"
. OCC. GROUP
'v RES. UNITS
DRAINS- FLOOR, ROOF, AREA,COND. '5,00
_
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor License Law does not apply to an owner of
I
FIXTURES %PER TRAP 5.00
'
GAS - EA. SYSTEM „I INC. 4 OUTLETS' 6.00
_
SQ. PT. FLOOR AREA
TOTAL ACREAGE
property who builds m improves fhercon; and who does such work
himself or ' through his own employees, provided that such improve-
ments are not intended or offered fnrsale. If, however, file building
or improvement is sod within one year of'complelimr, the owner-
builder will have the burden of proving teal he diet not build or am.
GAS - EA. SYSTEM - OVER 4 (EA.) -' 2.00
� n
BUILDING USE
pr a for purpose of sale.).' . •
1; as owner of the property, mn.oxclusively contracting with
RES ENO CON, Pa Other
E] o ❑ � ❑
INDUSTRIAL WASTE INTER. v 30.00
Y
LAWN SPRINKLERS - 1 INC 5 V.B. • 6.00
"
lice std contractors to construct the I'T"I (Sce. 7044, Business
Slid Professions Code: The Contractor's License Law does not apply
ASSESSORS PARCEL NO.
to an owner of properly who buflds'or improves Ihercon: and who
LAWN SPRINKLERS - OVER 5,(EA.) 1.00
contracts forsuch mejecls,eifh'a contractor(s) licensed pursuant to
the Contractor's License Law.
❑ lam exempt under Sec. ,U. &P.C. Ibr this
maSOn
S EWER- SANITARY -STORM EA. 200ft /10.00
TRACT NO.
PARCELING.
WATER HEATER W /VENT 6.00
-
Owner /J ��(�_ D:ne /
WATER SYSTEM 5.00
'
ACC. DATE
ACC. FILE NO. -
WATER TREATING EQUIP. 5,00
woRKERS'COMPENSATION DECLARA.TION
I herchy affirm that 1 have a Celt ifcate of consent to sell-insure,
ZONING
ENG. SITE NO.
or a certificate of Workers' Compensation Insurance, or a certified
copy thereat (Sce. 3800, Lab.C.l:
-
policy No - CamPany
_ -
-
❑ Certified ' copy Is hereby furnished. -
❑ Certified opy, is filed vith the city Inspe.UOn •division,
Applicant _ t, _
. /
MISC. - REFER TO ORD.
FIRE,SPRINK -
Y N�
ENERGY.T.24
Y�'NQ',
.,
CERTIFICAT' Ii OF EXEMPTION FROM WORKERS'
- COMITNSA'fION INSURANCE
not
(This section need not he complcled if the permit is foe one
I PERMIT ISSUANCE 10.00
FLOOD ZONE
Y N�
A. L. U.C.
-
YE] No
PLO. CONTE. LIC. NO.
,PLG.
TOTAL
hu(This dollars (need
,
1 certify that in the perl'onnance of the work for which fills re,
mit is issued, 1 shall.not employ any person in any manner so as to
CITY
_ MECHANICAL PERMIT
FEE
FEE SUMMARY
BUILDING
D dA
become subject to fire Workers' Compensation Laws of C,.1:1ornla.
Datc Applicant ' -
ALTER OR ADD TO MECH. 5.00
NOTICE: TO APPLICANT: If, aftv,awking This Ccrf ificatc of fix
APPLIANCE '5.00
PLAN CHECK
FEE -
f
emption; you should become subject to the Workers' Compensation
provisions of thc,LOboi Code, you must ItHiliwith comely will(
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10,000C.F.M.) ' 4.00
-
' CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT (OVER 10OW C. F.M.) 6.00
SEISMIC FEE
4 ✓'
I hereby 'affirm thul'there is 'a construction lending agency for
EXHAUST HOOD (WITH DUCT)' 5.00
'
file performance of file work for which this permit is issued (Sec.
3097, Civ.CA -- ± '
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
der's
LenaJress
HEATING UNIT (OVER'100,000 B.T.U.)9:50
ELECTRIC
I rertil'y' that I have R,mi this application and stale that lhcabovc'
,
VENTILATION FAN (SINGLE)- ' s 4.00
ormaf ion is correct. 1 agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby atiliontd property for inspection purposes. • -
above- ,authorize roperty fo eves ec Phis sty to enter upon the
PLUMBING
BOILER - COMP (3 H.P. or 100,000 B.T.U.). 6.00
-
-
BOILER -COMP (Over 160,000 BTU) SEE FEE SCH:
MECHANICAL '
(We) agree to save, indemnify and keep harmlcss the City of
MISC. - REFER TO ORD.
upertino aganst liabilities, judgments, ants and expenses which-
ay in any way accrue against said City in consequence of the
m • of this r if.
PERMIT ISSUANCE ;10.00
CONST. TAX
-
"
MECH. CONT. LIC: N0. MECH.
DTAL
TOTAL
-
Signature of Applicant /Contractor U
OFFICE COPY '