15071 POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER
w CITY OF CUPERTINO 15071
INSPECTION DIVISION
JOB INSPECTION RECORD
q �
J PERMIT EXPIRATION'
JOB ADDRESS- �O '/2i L —'�� �� _= UNIT# _LOT# � * pERMiT EXPIRES IF WORK
01WNEFT. ,L',= ��-[l v CONTRACTOR. .' I/(/,(f CJ' " L (- LO'NT-C '.IS; NOT STARTED WITHIN
IN P CTION DATE INSPECTOR INSPECTION RECORD 18 11of PERMIT_Issu `.
. ANCE OR 180 DAYS FROM
FOUNDATION NOTE: '
UFER
_ v, ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
TO COMPLY WITH-THE APPROVED PL'ANSAND CITU OF PCI+tiiIT vnu Dn noN
PREGUNITECUPERTINO STANDARDS. - ` '!T • ,
GARAGE SLABS .., -'-.-"i
.. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -���tS' U„✓�t Is-(eC
- UNDERGROUND /SLAB W .,j ..'�; �;
J .
PLUMBING ' `
C
i ( T9Za 4t
ELECTRICAL - ISSUANCE bnrE
ELECT.
BLOC ELECT. PIG. MECR
MECHANICAL -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDp BUILDING PERMIT
M•' ' INFORMATION
- WOOD FLOOR _ - - VALUATION SIFT.
PLUMBING ,+ Cha..
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING "
sroRlEs TYPE rorvsTR.y
INSULATION • a
' OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO IT FLOOH AREP TUr AL'ACREAGE
ROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
DIAPHRAGM BUILDING USE
RES IND- ,CDN PB 01,....L ROOF SHEATHINGEl- -
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE' ` INS -
P ❑
, .nBSESSOHS PARCEL NO,--
ROUGH SAN.N
PLUMBING ELECT.ENERGY'
rano rvo. .PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY '
MECHANICAL - MECR.ENERGY
ACC DATE ACC,FILE NO
ELECTRICAL -BUILDING ENERGY. -.
FRAMING. ELECT.FINAL TEST - ZONING •;` ENG.SITE NO.
INSULATION PLUMBING -
GAS TEST - - GAS - -
FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '',❑ No. .. � ' NE_]
FLOOD ZONE A UC.'
- EXTERIOR SHEAR' ELECTRICAL RELEASE v NQ v 0, . �N❑
INTERIOR SHEAR FIRE DEPT:
• SHEETROCK GRADE FEE SUMMARY.
EXTERIOR LATH BUILDING -
INTERIOR LATH; TEMPORARY APPROVALS BUILDING
SCRATCH COAT '. ELECTRIC'. PLAN CHECK-
' - -•« .: "FEE'
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE 7f)
OCCUPANCY OF BUILDING IS NOT PERMITTED UN TIL B UILDING FINALISSIGNEDBY BUILDING INSPECTOR: ,MICROFILM
uj ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
ONE WORKING DAY-BEFORE REQUIRED INSPECTION. PLUMBING
o,� PLEASE GIVE JOB ADDRESS WHEN.PHONING:
Z .. MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
AMRORTANT!
CONST.TAX
'PLEASE READ REVERSE SIDE BEFORE TOTAL /6- r G1
CALLING FOR FINAL INSPECTION.
OFFICE COPY."
APPLICF„NT TO FILL IN INFORMATION WITHIN.RED LINES USE BALL POINT PEN ONLY
-''BU I LDING PROJECT I DENTIFICATI ON - PERMITNUMBER •
BUILDING APPLICATION & PERMIT
ADDRESS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 15071
PLAN CHECK VALIDATION
�( Y
AMC
QTY. ELECTRIC PERMIT FEE ± I0 �'
PHONE z
CONTRACTORS
CIA., ) J UTLETS-SWITCHES--PIECED 10.00/1.00
Iy1/ -
LS/I 1(11n� 6PITITa�JI Ic.No. �s/7 LIGHTING FIXTURES 10.00/1.00 .•
CONTRACTORS fa�. - PPLIANCES-RESIDENTIAL 4.00 '
DDREss ��(� Ave. (� ((�� ` //�r••��t
ZZ . eon& APRONE gg6�56n PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT
PANELS (OVER 200 AMP)', 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. SIGNS.TRANS. 3.00
ARC"
ADDRESSOR ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP " ' EMP.METER,OR POLE INS. 20.00 - n'
AAPPLICOGRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 - /
0 o LICENSED CONTRACTORS DECLARATION
a i 1 hereby affirm diel I am licensed ower provisions of Chapter 9 ISSUANCE DATE <
w Q h (commencing with Section 7000)of Division 3 of the Business and - BLDCy ELECT. PLG. MECH.
r y z Professions Code,' d my)icon og
Li is in full force.'m1 fli ❑ ❑ ❑
0 0 w C License Class Con Nwn be D Or.
_ Date Contractor p(q
m r {I1�7
a rc s ¢ OWNER-BUILDER DECLARATION F - BUILDING PERMIT
w ;w U INFORMATION
LL H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H w w to Lew for the following reason.(Sea 7031.5,Businessend Professions PERMIT ISSUANCE - - VALUATION S/FT.
Sw0 � Code:Any city or county which requiresa permit to construct,alter, 10.00
¢ ¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. (p !
n0¢ requires the applicant for St Ch permit to file a signet)statement that TOTAL PERMIT T
w S - he is licensed pursuant to the provisions of the Contractor's License
FIQLaw(Chapter 9(commencing with Section 70000of Division 3 ofthe
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant(or a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP -
their Sole compensation,will do the work,and the structure is not RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAII(1S-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves themon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
�•' himself or through his own employees,provided that such improve.
buttons are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4.OUTLETS 6.00
or Improvement Is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sole.). RES IND CON PB Other
- INDUSTRIAL WASTE INTER. '30.00 '
❑ L as owner of the property,out exclusively Contract ing with
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLE. -1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply "•
to trownerof supropertywinbuildstr improvesthereon,nand who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such cense L wish a conlaclortx)licenses pursuant In
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION 111lATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate ofconwrit to self-insure.
or a certificate of Workers'Compensation Insurance,'orla cc H lfied ZONING ENG.SITE NO.
'"Y^ copy thereof(Sec.3800•Lah.C.). /I17.�,TL d
Policy No. Cnm Pany 1. - '
❑ Certified copy is hereby furnished.
Z Z ❑ Certifiep [o tided with Ihe' II i cello ,1�I FIRE SPRINK ENERGY T 24
p: Of Applicant 1UA/SA OGd/va6 C�ArrtXf�^l aAAw MISC.- REFER TO ORD. •v [:] N� vC] IN
N C F RT 117(CAI hi O F EX I iM PTI ON F R(I M.WO R K 1i RS' PERMIT ISSUANCE 10.00 FLOOD ZONE _ A.L.U.C.
LU COMPENSATION INSURANCE PLO.CONTE. LIC.NO. PLG.
1 O (This section need not be Completed it the permit is for one TOTAL Y NEI Y N�
L 2 hundred dollars(8100)or Icss,) - -
U O l certify that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner sD as to
U become subject to the Workers'Compensation Laws of California.
U i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING S Sa
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex- _
FZ comfort,you Should become subject to the Workers'Compensalion .APPLIANCE. 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U Such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LEN DING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 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,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.)' 8.00 '
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
Icertil'y that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 `
ordinances n correct. 1 agree to comply wi0i all city and county BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) •6.00 PLUMBING
hereby
ordinances and state laws aliverelating to building construction and
hereby authorize representatives tar ties of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpous.
(We),agree "' save'
indemnify-and keep ha nn less the City'ot MISC.-. REFER TO ORD.
upertino against liabilities(judgments, costs and expenses'whicb PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue again said City in conseq hence of the
pending of of this permit -/ MECH.CONT. t LIC NO. MECH, q
SI na�"'t e✓�lS ��/ TOTAL' , TOTAL �jp 7o
g pp cant/C trocar Date .�
OFFICE COPY'