180091
POST THIS CARD NEAR ,FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION' .
JOB INSPECTION RECORD
; y. .41 —lie/ e
(JOB ADDRESS �J ( •_ UNIT#' _LOT#
^� K," �
OWNER •D4- CONTRACTO L� {�'J
RNnrNDMBER ..
18009
ERMIT/E' RATION
;PRIM Q] R.S.II ,"
IT`•EXI�IRES °i��W�RK
IS NOT ST4 TED, WITHIN
180DAVS OF PERMIT ISSU.-
"ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
. INSPECTION
DATE
I IN.SPECTOR
INSPECTION RECORD -
FOUNDATION
- ..
NOTE:.' •
' ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS. -
UFER ,'
' PREGUNITE "'
/ eR a vnu on noN
i
2 ISSUANCE PAnt "
GARAGE SLABS
• YOUR NO CONCRETE UNTIL ABOVE HAS BEEN
SIGNED
- UNDERGROUND/SLAB'
PLUMBING -
PAW
ELECTRICAL
MECHANICAL
AUG 14
,BUJ G�.
ELCCT.
PLLU. MLC�H/
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
pf
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VACUAUON SIFT.
/��p
_
' PLUMBING �
' `
� �
MECHANICAL
ELECTRICAL
-
-
,
/�j`,}� PERM1BT To
'i/'M.:J%7,•lfl! /E QJ7�.
FRAMING .. I_,
INSULATION
- - - -
STORIes
TYPECO"STR.
-
, -
OCC GHOUP
RES. UNITS
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED-
-
ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
5• " -,
50. FT. 41001+ AREA
^ M\f
TOTAL ACREAGE
DIAPHRAGM
ROOF,SHEATHING,'�
BUILDING USE
Res IND CON PB Om,•,
El ❑' 1] 1
APPLY NO ROOFING UNTIL.ABOVE HAS BEEN SIGNED
`FINALS, '' +.
DATE
INS P.
ROUGH
SAN.a
ASSESSORS PARCEL NO
'
PLUMBING -' >
ELECT, ENERGY
TUBS 8''TRACT
SHOVJER PAN.
PLUMBING ENERGY
�'
NO.
'PARCEL NO.
-
MECHANICAL''
'MECH. ENERGY"
ELECTRICAL
2
BUILDING ENERGY
ACC PATE
ACC FILE NO.._
FRAMING
ELECT. FINAL TEST
-INSULATION
2
PLUMBING
zoNlrvc.
ENG, SITE No.
GAS TEST
GAS
'
-
MECHANICAL
F IRE SPRINK
Y "�°
ENERGY T24'
"�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING - .. '
I
EXTERIOR SHEAR �'�
,ELECTRICAL
RELEASE
FIRE DEPT.•'
,-
FLOOR2pNE
Y ❑ N❑
A, L U .C.
` ❑ - 1:1,
INTERIOR'SHEAR "-4
.,
SHEETROCK •-
GRADE . , „
FEE SUMMARY
EXTERIOR- - LATH -. -
BUILDING '•
BUILDING -
G
80;•i
:INTERIOR ;LATH. "`
TEMPORARY APPROVALS -
SCRATCH COAT - -
ELECTRIC
PLAN CHECK
FEE -
GAS
NO TAPE OR PLASTER UNTIL -ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING.IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
'MICROFILM
LU!,', ,.' .,ARRANGE:FOR INSPECTION BY PHONING -252 -4505, '.
I= ONE'..WORKING DA'Y BEFORE-REQUIRED INSPECTION.
o PLEASE GIVE JOB ADDRESS WHEN PHONING.•
- SEE. PERMIT FOR,EXPIRATION DATE - ,'. :"
ELECTRIC
Sp
PLUMPING
MECHANICAL.
CONST. TAX :..i
"y
IMPORTANT! . .'.
PLEASE READ REVERSE'SIDE.BEFORE .-
CALLING FOR FINAL..INSPECTION.
TOTAL
//
�p.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY '
BUILDING PROJECT IDENTIFICATION
-
P APPLICATION & PERMIT
BUILDING- ,ELECTRICAL- PLUMBING- MECHANICAL
PERMIT NUMBER
1 (��5 /y�
''• 1 8009
4 4 T
-
Fez HONE
CITY.
, ELECTRIC PERMIT
I
FEE: +
-
PLAN CHECK VALIDATION
` ^��x��•
�, x C
-' '
Yr�V! 13
DATE OF APPLICATION
NAMERACTDR's
�. (.� LC.NO. 5 14LI7J
UTLETS - SWITCHES - RECEP 10.00/1.00
/0.00
L'I G HTI NG,FIXTURES 10.00/1,00
oZ j
COry AcN
ApDRE55�
PRONE
APPLIANCES - RESIDENTIAL 4.00
PANELS IO.00
ARCHITECT
ENGINEER 11.G'1Vi`L
_
rvo.
;V 200 AMP) 20.00
IO
PLAN CHECK FEE P.C. NO.
-
SIGNS
SIGNS TRANS. 3.00
ARCH, OR Ervc.
pDB
zw
SPECIAL CIRCUIT 6.W
A.Pk;nI T VALIDATION
r
ISSUANCE DATE
ISSUANCE
ELECT. PPLO.� MECH.
LJleY
TEMP. METER OR POLE INS. 20.00
APPLICANT S
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CON TRACTORS DECLARATION -.
[,hereby ullirm that I am licensed. linerpmvislon'sof Chupt"r)
(commencing with Section 7000) of Division 3 of the Business' and
Professions Code, gild my licenu is in full rte. y
License la'sp�R Lie. Numb ( •� 1�
Dale =� L-�- Conlracto�
OWNER- BUILDER DIiC1.ARATION
1 hereby affirm that 1 am exempt from'[he Contractor's License
Law for the following reason: (Sec. 7031.5f rr Business and Professions
Cade Any mulish cormly which Structur a pwmino C-rmstmCL aOeq
Improve, demolish, or repair any structure, prior n Its issuance,
ateme t also
Rectums ilice he applicant far such permit to file a signed statement License
he is licensed pursuant to the provisions of the Contractor's ivi License
Law (Chapter dPm(Commencing Ai.RI da) with Section 7s C0Crn Dther,a3of the
Business and Professions Code) or that lie i is violation of therefrom and
the basis for the ulleg W exemption. Any violation of Section malty
by any applicant fora permit sdollars file 5000.)cam macivil penalty
of not mom if an five hundred dollars (5500)J: � '
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended'., offered for sale (Sec. 7044, Business. and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves Thereon, and who does such work
himself or through his own employees, provided that such improve-
meats am cut intended or offered for sale. If, however, the building
or Improvement•is sold within one year of completion, tlic owner/
builder will blive the burdan of proving that he did not Mould or im-
prove ror purpose of
❑ I, as owner of the property, am exclusively Contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The C'ontractor's License Law does not amply
to an owner of property who builds of improves thereon, and who
contracts far such. projects with a contractons) licensed pursuant to
the Contractor's License L.W.
❑ lam excinpt under Sec. ',i {, &P.C. for this
on
IR
. ,�
BUILDING PERMIT
INFORMATION
MISC. - O ORD
-
PERMIT ISSUANCE 10.00
VALUATION
$ /FT.
ELEC. CONTR. - LIC. ND.
,AA�CSK �, �• ;
ELEC. /'j LL
TOTAL ('t JD
PERMIT TO
'rte -•ES l
OTV.
.. PLUMBING PERMIT
-
ALTER- DRAIN &VENT- WATER(EA.) 5.00
FEE (
STORIES
TYPE CONSTR.
TYPE
'.
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS_
;>
DRAINS - FLOOR, ROOF, AREA,COND. 5.00
FIXTURES -'PER TRAP 5.00
GAS - EA. SYSTEM - 1 INC. 4 OUTLETS -6.00
56 FT. FLOOR AREA
TOTAL ACREAGE
•,
- .
GAS EA SYSTEM -OVER 4 (EA.). 2.00
BUILDING USE
RES IND CON PB Other
O 13 1:1 13
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS- 1 INC 5 V.B. -- 6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
,.
-
SEWER- SANITARY- STORM EA. 2001t /10.00
TRACT NO.
PARCEL NO.
WATER HEATER W /VENT 6.00
Owner Date-
WATER SYSTEM - 5.00
WORKERS'COMPENSA'f ION DECLARATION
•I hereby affirm that I have'. eeni0catr ofcanunt to ulf-imure,
or a certificate of Worker Compensation Insurance, or a certified
espy he ub.C.LLL
ppt�lI��kko,.
I'nlicyNo1LIh1rY'C away �TL Ise- (•�^�
O Certified copy is creby famished.
`a C tifLd��opy R�(tied �with m city inspection division.
nppiican�
ACC. DATE
ACC. FILE NO. '
WATER TREATING EQUIP. 5.00
-
ZONING
ENG. SITE NO.
-
MISC. - REFER TO ORD:
FIRE SPgINK
Y Q ` NE
ENERGYTP4
Y 0 N[3
-CERTIFICATE 017 IFXIi MPTION PROM WORKERS'
'COMPENSATION INSURANCE
(This uCtion need not he completed if the permit is for one
htmdred dollars f$100) or Iess.)
1 certify that in the performance of the work for which this per-
ntil is issued, I shall not anploy any person in any mm�ner so us to
become subject to the W arkersl Compensation Laws o(Calilbrnin.
Date Applicant
PERMIT ISSUANCE - - 10.00
FLOOD ZONE •
Y Q N[]
< A.LUC.
Y,[ r IN
P .CO TR. u N
C�• N' I %'
PLO. �[ A
TOTAL I T
OTV
MECHANICAL PERMIT .
FEE
FEE SUMMARY -
BUILDING
I
ALTER OR ADD TO MECH. 5.00
NOTICE '1'0 APPIACANT: If, after making this Certificate or lux.
caption, you should become subject to the Workera'Contpensation
Provisions of the Labor Code, you must forthwith comply with
such Provisions or this permit shall he ducnmd revoked.
• CONSTRUcrION LENDING AGENCY
I hereby abhoo,that there is a construction lending agency for
the performance of the work for which this,pennit is issued (Sec.
3097, Civ.C.l. -"
r
Lender's Name ''`
APPLIANCE 5.00
'
AIR HANDLING UNIT.ITO 10,000 C. F.M.) "4.00
PLAN CHECK
FEE
AIR HANDLING UNIT (OVER 1000C.F.M.) 6.00
SEISMIC FEE
3, ZZ
EXHAUST HOOD (WITH DUCT) _ 5.00
HEATING UNIT (TO 100,000 B.T.U.) 8.00
MICROFILM
-
�
I.Cnder'sAddress I'JL" 11�4
HEATING UNIT (OVER 100,000 B.T.U.)9.50
•ELECTRIC
I certify that I have read this applic Lion and state that the above
information n cstatel I agree to comply with all city and wand
ordinances and state laws relating to building construction, and
hereby aulhoriic representatives of this city to enter upon the
above- mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
upertirto against liabilities, judgments, vests and expenses whicli
may in any way accrue against saiA City in consequence ol'thu
'rant' gor his p• 't.
_ly_
VENTILATION FAN (SINGLE) 4.00
BOILER -COMPQ H.P. or 100;000 B.T.U.)'. 6.00
PLUMBING -
%y;e• --Q
BOILER -COMP (Over 100,000 BTU( SEE FEE SCH:
MECHANICAL
MISC. - - REFER TO ORD.
- PERMIT ISSUANCE 10:00
CONST. TAX'
MECH. CONT. LIC. NO. MECH.
&Cf. n U TOTAL
lA �• a 1441x` . _2/ •
TOTAL
SL 2 �
Lure of A lice onuuclor -;. Date
OFFICE. COPY