14645 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF ,CUPERTINO 14645
INSPECTION DIVISION
JOB INSPECTION RECORD ;.
PERMIT EXPIRATION
JOBADDRESS UNIT# :LOT# - - -
_ PERMIT EXPIRES IF WORK
owrvER 0014) CONTRACTOR �J GLr 6i- IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 1e0 DAYS OF PERMIT ISSU- -
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER - ALL GRADING'AND DRAINAGE SHALL BE INSTALLED'
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO.STANDARDS. -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB'
PLUMBING
ELECTRICAL ISSUANCE DA II
MECHANICAL - BLDG. ELECT • PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS-BEEN SIGNED BUILDING PERMIT'.,
WOOD FLOOR - INFORMATION ,
PLUMBING '
VALUATION $/FT." -
MECHANICAL
ELECTRICAL - - - e - - PL,p �4HHMITTO
FRAMING . - QP -�Lr, ^
INSULATION ` STORIES TYPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 FT FLOOR AREA TOTAL ACREAGE
ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE ..
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
9D I-DING USE
ROOF SHEATHING - ._RES IND CON Pn U"",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED .FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.p ASSESS ORSPARCEL NO
PLUMBING ELECT ENERGY '
,
' TUBS&SHOWER PAN.' , PLUMBING ENERGY � TRACTN(; PARCEL NO.-
MECHANICAL - MECH.ENERGY '
ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE No
FRAMING -
INSULATION ELECT.FINAL TEST "
OLING ENG.SIZE NO,
PLUMBING
GAS TEST GAS
MECHANICAL
FIRESPRINK ENERGY T-24
' -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ "❑ 'Y ❑ NO
EXTERIOR SHEAR
ELECTRICAL_ RELEASE FLOOD?,CNC ALU.C.
-INTERIOR SHEARFIRE DEPT.. _ Y❑ N❑ ❑ N❑
SHEETROCK .. GRADE FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR-LATH TEMPORARY APPROVALSBUILDING .
SCRATCH COAT - ELECTRIC' - PLAN CHECK .
GAS• FEE -
T' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINALIS SIGNED BY BUILDING INSPECTOR. MICROFILMLU ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY-BEFORE REQUIRED INSPECTION. PLUMBING• • I' /
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL.
IMPORTANT! consT.rax
PLEASE READ REVERSE SIDE BEFORE TOTAL / Lt
CALLING FOR FINAL INSPECTION.
OFFICE COPY'
•`APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
.BUILDING PROJECT,I DENTI FICATION , 'PERMIT NUMBER
e�,aD,NG APPLICATION & PERMIT . 1 ,4645..
•',,; ADORE s BUILDING —ELECTRICAL—PLUMBING—MECHANICAL 1 I'Tn
6 T
p OWNER'S PLAN CHECK VALIDATION
' NAME CITY. `ELECTRIC PERMIT FEE
I.&St ONE 33=
cONTRAC�T]O.qIss� - -UTLETS-SWITCHES-RECEP 10.00/1.00 '1v
- LIGHTING FIXTURES. 10.00/1.00
' rorvTRACToas
ADD,
D - APPLIANCES-RESIDENTIAL 4.00 "
• /DRs C
� r ✓ PHONE. PANELS 10.00 DATE OF APPLICATION
ARCHITECT , - PLAN CHECK FEE RC.NO.
OR PANELS (OVER 200.AMP1 20,00 -
ENGINEER '
LIC.No. SIGNS TRANS. 3.00
AARC"DDRE09 SS ENG ' SPECIAL-CIRCUIT' 5.06 .PERMIT VALIDATION
- zip I EMP. METER OR POLE INS. - 20.00 ADDRESSrsMOTORS SEE FEE SCH.RL
APP11CASERVICE CHANGE• 20.00,a, oLICENSED CONTRACTORS DECLARATION1 hereby affrto that 1 am licensed order provisions of Chapter 9 - - ISSUANCE DATE
z (commencing with Section 7000)of Division 3 of the Business and
¢ ELECT. 'PLG. _MECH,
F y i Professions Co�1q al�naYlicen Li I9 m full For ff ? _
z O m — License Class�' b�Lm Number !
.o i- LE Date Contractor �
a a E r.' . - - - ��— ' BUILDING PERMIT.
.¢ a a OWNER-BUILDL:RDECLARATION INFORMATION
wg a- r I hereby affirm that"I am exempt from the Contractor's License MISC.'— - REFER TO ORD
F u. O J Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION '$/FL
Code:Any city or countywhich requires a permit to construct,alter,
¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC
O u Ci requires[lie applicant for such pennt'[o file a signs 1 statement[hal + .TDTAL
whe is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Law(Chapter 9(commencing with Section 7000)Il Division 3 of the - t �L�f Cr
¢ vr Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ F m the basis for[he alleged exemption.Any violation of Section 7031.5 +" STORIES TYPE CONSTR.
ai — by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN•&VENT-WATER (EA.15.00
of not more than five hundred dollars($500).1: _ "
❑'1,as owner of the property,or my employees with wages as - BA'CK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
., their sole compensation,will do tae work,and the structure is not
intended or offered for sole(See. 7044; Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Low does not apply to an owner of
property who builds or improves lhereon;and who does such work FIXTURES-PERTRAP '5. SO.FT.FLOOR AREA TDTAUACREAGE
himself on through his own employees,provided that such improve.
ments are not intended or offered for sale,If,however,thabuilding GAS-EA.SYSTEM-I INC:4 OUTLETS
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did mit build or im= GAS:EA.SYSTEM-OVER 4 (EA.) 2.0 BUILDING USE
prove'forpurposeofsale.). INDUSTRIAL WASTE'INTER. RES IND 'CON Pa . Other
,❑ I,as owner of the property,am'exclusively contracting with VlI El El 1:1 - 11 licensed contractors to construct the project(Sec. 7044,•Business LAWN SPRINKLERS-1 INC 5 V.B. 6,00 - ASSESSORS PARCEL NO. -
andProfessions Code:The Contractor's License Law floes notapply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLE_RS-OVER 5(EA.)
contracts for such projects with a contractor(s)'licensed pursuant to -
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 ' TRACT NO. PARCEL NO.
❑ lamexemptunder Sec. ,B.&P.C.I'Or th is WATERHEATER W/VENT ' 7 6.00
reason
Owner - bate WATER SYSTEM 5.00 -
ACC.DATE ACF FILE NO.
WORKERS'COMPENSATION DECLARATION. WATER TREATING'EQUIP. 5.00 "
V
I herebyaITDo' thou Lave a clotificote of consent to sclFivameq -
or a certificate of Worke s'Compensation Insurance,at certified ZONING ENG.SITE NO.
eoPY the 00, ab.C)JI//
Policy N Com any -
O �!L Ce 1 opy is he by furnished. RE SPRINK ENERGY T-44
z z ❑ Cert ie cop is ed with ,the city Inspection division. -
H O Applicant �„L„ — - MISC - --, REFER TO ORD. Y.[:J N❑ Y,❑ N❑ .
W CI!_RT F CA'I'E OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 /4CJd FLOOD ZONE A.L.u.c.
LU — COMPENSATION INSURANCE PLG.CONTR. "LIC.NO. PLG.
,d 0 (Thls'.etiou need not be completed if the permit is I'or one - . 'TOTAL 1660 - Y ElN❑ Y [:] N❑
- D Z hundred dollars($100)Or less.) - - - -
U O I certify that in the perfonirmce'ofthe work for which this per' CITY. MECHANICAL PERMIT FEE 'FEE SUMMARY
. LL F mil is issued,I.shall not employ any person in any manner sea as to -
O w become subject to the Workers Compensation Laws of California. .
Q. Date—Applicant' - BUILDING
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR`ADD TO MECH. 5.00
Z empthm,you should hecome subject to the Workers;Compensation APPLIANCE' _ 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE '
such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) '4.00
CONSTRUCTION,LENDING AGENCY. AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
I hereby affirm that there Is a construction lcandlngagency for EXHAUST HOOD (WITH DUCT) 500 .;
the performance of the work for which this permit is issued(Sec MICROFILM
3897 CIvC). " HEATING'UNIVTO 100,000 B.T.U.)-,800 ' '
Lender's Name HEATING UNITIIOVER 100,000B.T.U.)_9.50
Lender's Address - ELECTRIC -
I ccrtit'y that I have read this apphcabon and state that the above VENTILATION FAN (SINGLE) r xI 4.00
information is correct. I agree to comply with all city and county - PLUMBING �QV
ordna ewand slate laws relating to building construction, and BOILER-COMP(3 H.P.Or 106,000 B.T.U.) 6.00
hereby enthoed ropertyfor insves ee this city to*es.". er'upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. . MECHANICAL
above-mentioned property forinsp ofthipurpos s - e
(We) agree to save, indemnify and kcep�hannless the City of MISC. REFER TO ORD
r upertian against liabilities,+judgments, costs and expense,which` PERMIT ISSUANCE -10 00 CONST.TAX -
may any way cram against said City in consequence of the
ran n colli' per it. h MECH.CONT LIC.NO.
- TOTAL -TOTAL D VD
Signet r o Applicant/Contractor Uulc ,
OFFICE COPY