18047POST -THIS CARD NEAR FRONT OF -BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB`INSPECTION:RECORD
JOB 'ADDRESS �� �CL�llSO�-''�� UNIT#: LOT,
. - '- -
owNeR - e, ,� coNTRAcroRa�% .•
eR nNDMeER'•
gp�
RM1T-EXPI RATION '
/ //'•+ ((!' '+'
PERMIT/EXPIREB-I FIWORK
IS NQT�ST,RTEDj WFTHIN,
1Bo-6AV,h �PERN1IT issil�
OR 180 DAYS FROM .
LASTCALLED INSPECTION:
INSPECTION DA E'. INSPECTOR
'INSPEC ON RECORD
. FOUNDATIONANCE
- -
NOTE:'
ALL GRADINGAND -DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS'AND CITY OF:
CUPERTINO STANDARDS..
UFER", I -
PREGUNITE _
PEHMII VALIDATION
`�,,, • / ' -
(�f/(
+A` ISSUANCE OnrE - 'N+
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' - -UNDERGROUND /SLAB"
` PLUMBING.
ELECTRICAL. .
MECHANICAL -
p..H
Da
ELECT I PLc: MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
.T����
BUILDING PERMIT ;„,yE,
INFORMATION g
-” WOOD FLOOR
-
PLUMBING
VALUATION
S/FT. '
MECHANICAL".
ELECTRICAL
MIT
'-,r.'"�,' •�{s-
I I
leir�_l
:.FRAMING•.,,.
INSULATION •.i
., - ,
ST IE
YPE CONSTRV
n
-
OCC GROUP
RES UNITS V,
:P.,LACE$NO SUBFLOOR UNTIL ABOVE HAS BEEN -SIGNED
ROOF
NOTE: NO FINAL INSP. SHALLBE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so FT,FI-0 HEA
}�
JOUAL ACREAGE
DIAPHRAGM;` -
ROOF SHEATHING' -
BUILDING USE
HES IND CON PB Do.. -
❑
APPO NO ROOFING UNTIL'ABOVE.HAS BEEN SIGNED
.,FINALS ",~''`DATE :INSP. :
`"-
ROUGH.
SAN.N--; .,
ABSESSORS PARCEL NO -
-
PLUMBING'' -
ELECT. ENERGY
TUBS &SHOWER PA-
PLUMBING ENERGY ��
TRACT NO.
PARCPLNON'
MECHANICAL.
MECH.ENERGY
ELECTRICAL
BUILDING ENERGY
Acc. DATE
-
ACC FILE NO.
FRAMING�s l 'lt .'
ELECT, FINAL;TEST
INSULATION ^.:' -
PLUMBING
ZONING
-
ENG:'SITE•NOn
GAS TEST. -
GAS - -
MECHANICAL'
EIRE SPLINE .
❑ "
ENERGY T 2 ,
° El NE]
COVER,NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATINGj
EXTERIOR SHEARS
ELECTRICAL RELEASE
FLDOD 2UNE
`Y ❑ ' _NQ
A.IU,C.
v,L] "❑
.INTERIOR SHEAR
FIRE DEPT.
SHEETROCK _
GRADE
FEE SUMMARY
EXTERIOR. LATH t;
BUILDING
BUILDING
.INTERIOR LATH.
TEMPORARY APPROVALS
SCRATCH COAT • ,-'
ELECTRIC, -
-
`PLAN CHECK
FEE r,
_
...
GAS.._
GAS'
NO TAPE ORI UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY -
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITI-EO UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR..MICROFILM
-
'ARRANGE FOR INSPECTION BY PHONING.252-4505„
�� ONE'WORKING DAY -BEFORE REQUIRED,INSPECTION.'
z PLEASE GIVE JOB ADDRESS WHEN'P,HONING.
n "—`SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC.,
P)
PLUMefAc
MECHANICAL"
CONST. TAX
—
-IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING.FOR,FINAL INSPECTION.`
TOTAL'
. w f
OFFICE COPY. ' S
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION& PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBERBUILDING
x
E:' 18 4
ADDRESS
2240-5-L &IL SrA4 I
OWNER'S
NAME
ARAAIC/S KEELEyt 25�-6�
PHONE
- -.
CITY ELECTRIC PERMIT FEE
1CONT
- 'TgLpNV: LIDATION
111//Ir/ ^7 �/
/
ap,OF.PCA N
NAME croRs,
NAME / "
✓�Avey. CpNs„XernLQC^�D .
UTLETS- SWITCHES -RECEP 10.00/1.00 O.d
LIGHTING FIXTURES 10.00/1.00O
CONTRACTORS
ADDRESS
PHONE {. 2-0
PPLIANCES- RESIDENTIAL - 4.00 -
PANELS 10.00
ARCHITECT
OR E�LO
OR ����/"
uC. No.
PANELS (OVER 200 AMP) - 20.00
PLAN CHECK FEE P,C ` NO.
SIGNS TRANS. - 3.00
ARCH. OR ENG.
ADDRESS yap ZIA., % fI vEJ.STE �.3
zIPEMP.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
,
ISSUANCE GATE
OC. ELECT. PLG. MECH.
jQl ,
LJ„
METER OR POLE INS. 20.00
APPLICANTS
S
ADD -
;?2g 0a5'6AL(J$ OL 67
MOTORS SEE_ FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is In full force and affect.
License Class Lie. Number-
umber
Data
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt faun the Contractor's License
Law for the following reason. (Sec. 7031.5, Businessand Professions
Code: Any city Cranially which requirese permit to construct,,alter,also
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Canlrmtor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 at the
Business and Professions Code) or that he is exempt therefrom and
the basis for Ilia alleged exemption. Any violation of Section 7031.5
by any applicant fora permit subjects $5000.applicant IRS civil penally
of not more owner
five hundred dollars (55 emp with wages as
❑ Las owner of the property, e o r . and the
their sole compensation, will do the work, and the slrucHme is not
intended or offered for sole (Sec, 7044, Business and Professions
Code 'The Contractor's License Low does not apply to all owner of
. property, who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sa)e. If, however, the building
or improvement is sold within one year of completion, the owner-.
builder will have the burden of proving that he did not build or int-
prove for purpose of sale.).
1, as owner of the r contracting with
am exclusively . 7044, B
p construct
licensed contractors to construct the project (Sec. 7044, BusinessLAWN
and Professions Code: The Contractor's License Law does not apply
thereon, and who
to antr owner of property who builds tr improves licensed
contrails for such projects with a contr:u.9olfs) licensed pursuant to
the Contractor's License LBW,
❑. I am exempt under Sec. ,If,&P.C. for this
RJin
IDA
-
J' 4 - r -
$rraa� QQ���R��
Gill M CUPA �
BUILDING PERMIT
INFORMATION
MISC.- REFER TO ORD
10.00 1,
PERMIT ISSUANCE �• uV
VALUATION
$/FT.
ELEC. CONTE. LIC. N0. �
s
ELEC. //tt
TCI too
PERMIT
STO E
TO -
YPE CONSTR. •,
'
OTY. - PLUMBING PERMIT FEE
ALTER-DRAIN&VENT-WATER(EA.) 5.00
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 -1INC. 4 OUTLETS 6.00
SO. FT. FLOOR AREA
y
's2J E7"\MI
TOTAL ACREAGE
GAS • EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Other
INDUSTRIAL WASTE INTER. '30,00
SPRINKLERS - 1INC 5 V.8. 600
, .
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO,
'
SEWER -STORM EA. 200ft/10.00
TRACT NO.
PARCEL N0.
WATER HEATER W/VENT 6.00
Owner Dose'
WORKERS' COMPENSATI -CLA RAT ION
I batch, affirm that I have a car if a of consent m self -insure. or a certificate of Workers' Compe sation Insurance, or a certified
copy therbof(Sec. 3800, Lab.C.).
Policy No. -Company -
o. Company
WATER SYSTEM. - 5.00
ACC.OATE
ACO. FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO,
0
❑ Certified copy is hereby famished'
13 Certified copy Is filed whit Ilia city inspection division.
Applicant
MISC.-' REFER TO ORD.
FIRE SPRINK
YC] N❑
ENERGY T -Z4
Y0 NC]
cERITFICATIi OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE -
(This section need not be completed if the pannit is for one
hundred dollars IS 100) or less.)
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
become subject to the Workers' Compensation' Laws of California.
Date - Applicant
PERMIT ISSUANCE 10.00
FLOOD ZONE
Y ❑ N�
A. L.0 c.
Y ❑ NC]
PLG, CONTE. LIC. N0. '
PLG.
TOTAL
OTV. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
-
(.(J
. .
ALTER OR ADD TO MECH. 500
NOT ICE TO APPLICANT': If, alter making this Certificate of lix-
emptietestd, you should become subject to the Workeri Compensation
such proviro RESsi ns or this of The bor pero t shall be deemed ren most evoked hwith comply with
CONSTRUCTION LENDING AGENCY
I hereby affirm that. there is a construction lending agency for
the performance of the work for which this penuil is issued (Sec.
3097, Civ.C.).
Lender's Name
APPLIANCE 5.00 '
PLAN CHECK
FEE
~�
AIR HANDLING UNIT (TO 10=C.F.M.)' 4.00
AIR HANDLING UNIT(OVER 10=C.EM.)6.00
SEISMIC FEE
5ln
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Address -
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building Construction, and
herebymentioned properly representativesthis city to enter upon the
hereby authorize representatives inspection
of this
purposes, to.
(We) agree to save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs and expenses which
may in any way accrue against sai City in consequence of the
rand fill, p it.
HEATING UNIT (OVER 100,000 B.T.U.)8.50
ELECTRIC
0. QD
VENTILATION FAN (SINGLE) .4.00
-
BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00
PLUMBING
BOILER -COMP IOvar 100,000 STU) SEE FEESCH.
MECHANICAL
MISC. - REFER TO ORD.
PERMIT ISSUANCE r •10.00
-
CONST. TAX
-
MECH. CONT. ,LIC. NO. MECH.
TOTAL,
TOTAL
Signature Of APPLicanticontracto Date
v OFFICE COPY